Minister for the Oceans
 - Question

Baroness Jones of Moulsecoomb: To ask Her Majesty’s Government what assessment they have made of the case for appointing a Minister for the Oceans.

Lord Goldsmith of Richmond Park: My Lords, ocean protection is vital for the domestic and global economy as well as for nature, of course, and that is why we have several Ministers across government covering different aspects of the marine environment. We work together to deliver our ambition for healthy, productive and sustainable oceans through the effective management of UK waters and by championing ocean protection internationally. The range of ministerial portfolios covering the marine environment is both a reflection of the priority that we afford the ocean and the need to integrate ocean considerations across government policy, from biodiversity and climate change to energy and maritime security.

Lord Foulkes of Cumnock: What a brilliant Answer.

Baroness Jones of Moulsecoomb: Well, actually, if I could be allowed to speak—

Lord Foulkes of Cumnock: Sorry.

Baroness Jones of Moulsecoomb: I do not find it to be a brilliant Answer at all because it sounds like everywhere and nowhere to me. The oceans are a huge entity with billions and trillions of ecosystems. This is about not only their protection but understanding our impact on them, which might be good or bad. Should not the first job for the Minister today be to go back and ask for one good person to be a Minister for the Oceans so that they can be understood and supported?

Lord Goldsmith of Richmond Park: My Lords, the noble Baroness is right about the importance of the ocean but that is why this issue runs like a thread through most departments of government. The impact of our collective government approach is clear from: the success of the G7; COP 26, where we put nature, including the ocean, at the heart of our approach; our own extensive MPA network, covering nearly 40% of our domestic waters; our protection of 4 million square kilometres around our overseas territories; our leadership  of international efforts to secure protection of 30% of the world’s ocean by 2030; and our co-sponsorship only last week of the successful UNEA resolution on a new treaty on plastic pollution. I could spend much longer than I have done reeling off things that have been achieved on the ocean by that collective approach here in the UK.

Baroness Fall: Rising sea levels are a national security issue as well. They threaten the boundaries of countries, as well as countries full stop. If we are to avoid the wild west on the wild seas, with refugees left abandoned, can I urge the Minister to address this matter on a global level with colleagues?

Lord Goldsmith of Richmond Park: We absolutely do address this issue at the global level. There are many things that we need to do to restore the health of the ocean and protect what we have, but the single most important thing that we can do is to tackle emissions. The mantra “climate action is ocean action” is very much the case , which is why the oceans were such a central part of our presidency of COP in Glasgow just a few months ago and throughout our presidency this year.

Lord Teverson: My Lords, in terms of international humanitarian law, how would a future Oceans Minister reconcile our signature to the United Nations Convention on the Law of the Sea and the safety of life at sea convention with the Government’s policy to push back vessels to outside national boundaries?

Lord Goldsmith of Richmond Park: I am not 100% convinced that I followed the question, but the UK’s role internationally in standing up for the rule of law on our oceans is almost second to none. We have taken a strong position in the past few days in the BBNJ negotiations on the attempt to create a new framework. Other than perhaps France, which has taken a leadership role in recent weeks, no country in the world is doing more heavy lifting than the UK.

Lord West of Spithead: My Lords, I stand ready to be Neptune. I must congratulate the Government on a number of the measures they have taken to protect whole areas of the ocean around our overseas territories. However, as I have mentioned before, looking after those waters needs ships. It is no good just having satellites and aeroplanes. Even in this latest shipbuilding strategy, there is no coverage of the ships that might be able to do that task. In the context of the strategy, and looking to the future, will the Minister ensure that we have the ships to look after these waters?

Lord Goldsmith of Richmond Park: It is a really important point. Take South Georgia and the South Sandwich Islands, for example, where we have a large protected area. Those waters are policed by a UK ship that is paid for through very conservative sales of the right to fish for krill. The areas of ocean that we currently protect, combined with what we hope to protect in the near future, mean that the vessel approach is probably unrealistic. One of the things we  are trying to do this year is bring together the main donor countries and those countries most affected by illegal fishing to agree a global action plan. It will rely heavily on technology, which has advanced massively—even in the past 12 months—but has not been put to proper use.

Lord Bellingham: My Lords, given that 90% of the UK’s biodiversity is in the overseas territories, what plans does the Minister have to work more closely with the First Ministers of those territories on this agenda? Can I also suggest that he is doing an excellent job as the Minister for Oceans and we do not need anyone else doing it?

Lord Goldsmith of Richmond Park: I thoroughly approve of the second part of the question; I thank my noble friend. I am in regular contact with my counterparts across the overseas territories. There is a real hunger among our overseas territories to do more in not just ocean conservation but terrestrial conservation. There is real ambition there. We made provision for their representatives to have a serious platform at COP 26, which has not happened before. Their leadership shone through and inspired other countries to raise their game.

Baroness Hayman of Ullock: My Lords, does the Minister agree that a single Ministerfor Oceans could capitalise on our status as a maritime nation, bringing together offshore renewable energy, a sustainable fishing policy and blue carbon initiatives to harness the ocean’s carbon sequestration capacity and deliver huge environmental benefits?

Lord Goldsmith of Richmond Park: I am just not convinced that we would have abetter approach. We may enjoy self-flagellating in the UK but, outside this country, the UK is seen as a leader on ocean conservation issues, on ocean-related climate change issues and in standing up for the rule of law in international waters and beyond. I am just not convinced that having a single Minister would meaningfully change anything. This issue touches almost every department of government. It is therefore right that, instead of creating new positions, we focus on improving cross-government discussions.

Lord Fox: My Lords, the Minister has talked a grand game about policing the oceans of the world. Does he understand why we might be sceptical when the waterways under his and the Government’s direct control are infected with tonnes of sewage every day?

Lord Goldsmith of Richmond Park: That is a very different issue. The noble Lord will not be surprised that I disagree, but again I challenge him to give me a single example of another country that has either protected more waters directly or done more heavy lifting internationally to get the rest of the world to increase its ambition. More than 100 countries are now signed up and committed to protecting 30% of the world’s ocean by the end of this decade. That would not be happening if it were not for UK leadership.

Baroness McIntosh of Pickering: My Lords, my noble friend, as Minister for the Oceans, took a great interest in the passage of the now Environment Act, and in how the competing claims of fishing, shipping and new planning applications for offshore wind farms would be balanced. Have there been any further developments to put our minds at rest that future applications for offshore wind farms will have regard to fishing and shipping?

Lord Goldsmith of Richmond Park: This is an important point and there is a tension between our desire to scale up offshore wind, a sector in which the UK has a leadership position, and the need to protect our ocean and fishing sector. Defra is playing an increasingly important role, mostly through my colleague Rebecca Pow, and is liaising with BEIS and other departments, working to improve our understanding of the adverse environmental impacts and developing a cross-government approach to addressing them. In a few months, we will publish the findings of our recent consultation.

Baroness Ritchie of Downpatrick: My Lords, in advance of World Ocean Day, could the Minister indicate what action the Government will take to protect sensitive fish species and ensure that the by-catch is minimised, at the same time as underpinning our fishing industry throughout UK coastal communities?

Lord Goldsmith of Richmond Park: My Lords, before becoming a Minister, my noble friend Lord Benyon put together a report for the Government on highly protected marine areas. We are now taking those plans forward. These areas will take a whole-site approach and conserve all species in the key habitats we want to protect around our domestic coastline. We will provide more details of this programme shortly. In addition, through the new blue planet fund the UK is investing £500 million to help other countries, particularly small-island developing states which really depend on marine environments for their economies, to protect and defend those environments against the threats we all know about.

Inflation: Families
 - Question

Bishop of Durham: To ask Her Majesty’s Government what assessment they have made of the impact of inflation on the real terms value of the benefits received by families with children.

Baroness Scott of Bybrook: My Lords, by convention, the September inflation figure is used to uprate benefits. Any fluctuations year on year smooth out over time. In 2022-23, we will spend an extra £2.6 billion on benefits for people of working age, following the annual uprating exercise. We are providing £12 billion this year and next to help with the cost of  living. In addition, we recently announced support worth £9.1 billion to help households with rising energy costs next year.

Bishop of Durham: I thank the Minister for her Answer. By now, we are aware that the cost-of-living crisis will hit every one of us, but the Joseph Rowntree Foundation, Child Poverty Action Group, Resolution Foundation and New Economics Foundation all agree that it is going to hit families with children hardest, particular those with more than two children. They will see a real-terms cut in their benefits this year. There are further warnings of inflation of over 10% for the poorest families if the Ukrainian conflict continues and there are no plans for further mitigation from the Government. In this climate, can the Minister point us to parameters that demonstrate the ongoing apparent success of the two-child limit or does she agree that now is the time simply to scrap it?

Baroness Scott of Bybrook: My Lords, the Government understand people’s concern about pressure on household budgets and are taking action to help. We are working closely and monitoring the situation with the Bank of England. The Government are also putting in place policies to help families and individuals to meet the rising costs of living, such as increasing the national living wage and cutting the taper rate in universal credit. I am sorry to disappoint the right reverend Prelate, but we have no plans to change the two-child policy.

Baroness Lister of Burtersett: My Lords, ONS research shows that many are cutting back on basics in the face of the cost of living crisis, but what about parents struggling on inadequate benefits, the real value of which is set to fall by over 4% over the coming year? Many of them are already cutting back to the bone and cannot wait for next year’s smoothing. What are they supposed to do if the Government refuse to act on the growing calls for an additional increase in benefits?

Baroness Scott of Bybrook: My Lords, the Government are spending £6.6 billion this year in increasing benefit rates: £2.6 billion on working-age benefits and £4 billion on pension benefits. I agree that the uprating order was only 3.1%, but we have increased other rates, as I explained to the right reverend Prelate. We will continue to monitor it and, if necessary, will look in further detail.

Lord Farmer: My Lords, the right reverend Prelate’s Question raises the problem of cash flow. When inflation is climbing, as it is now, families are lagging behind the curve. What are the Government doing to help them with this negative cash flow at present? Also, the obvious way to increase income is to progress in work, including by moving into more skilled work. What are the Government doing to fill skill vacancies?

Baroness Scott of Bybrook: My noble friend is absolutely correct. As I said, we are providing support of around £20 billion this financial year to  help families with the cost of living. The most important thing must be to get people into work. Our expanded multimillion-pound Plan for Jobs is continuing to target tailored support so that universal credit claimants, including those already in work, can access the support they need. As my noble friend says, this includes skills development. It is really important to get people into work in the first place but also for them to progress in those jobs and earn more for their families.

Lord Woodley: My Lords, this below-inflation increase to social security is, in real terms, a disaster for the poorest and most desperate people in our society; there is no doubt at all about that. Can the Minister explain why the Government are once again attacking the poor, making them even poorer while the rich are getting richer in our country and society today?

Baroness Scott of Bybrook: My Lords, as I have said before, we are looking after the poor. We are investing in increasing benefits and, as we heard on 3 February, giving an energy bills rebate. We are giving £144 million of discretionary funding to local authorities and giving a council tax rebate to people in bands A to D, which is 80% of households in this country. The Government are doing everything they can and will continue to monitor the situation for people who need our help.

Baroness Janke: My Lords, the Minister talks about the importance of getting people into work, yet the maximum reimbursement for childcare has been frozen since 2005. The cost of childcare has doubled since then. Currently, in 99% of local authorities the cap does not cover a full-time place for a child under two, and in 9% of authorities it does not cover even a 25-hour part-time place. What plans do the Government have to review the reimbursement of childcare costs for parents and people on benefits?

Baroness Scott of Bybrook: The noble Baroness brings up an extremely important point. To get back into work, many families need good and affordable childcare. Universal credit claimants can claim up to 85% of their registered childcare costs each month, compared with 70% of those with tax credits. In England we are also giving 15 hours a week of free childcare to all three and four year-olds and to disadvantaged two year-olds, doubling to 30 hours a week for the working parents of three and four year-olds if they are claiming benefits. We have also introduced tax-free childcare and, if a universal credit claimant requires emergency help in the period before they get their first pay cheque, we have a non-refundable flexible support fund.

Lord Hannan of Kingsclere: My Lords, inflation is a malign and silent thief that, as we have heard from all sides, hits the poorest hardest. Beyond the obvious mechanisms of raising interest rates and switching off the printing presses, there are none the less things that Ministers can do to alleviate the cost of living crisis. We can bring down food prices by lifting tariffs, we can make it easier to build homes and, not least, we  can cancel the planned rise in national insurance. Does my noble friend the Minister think that there are levers that the Government could be pulling now to mitigate the impact of this terrible scourge on the poorest people?

Baroness Scott of Bybrook: The question my noble friend asks is probably a little above my pay grade. I will go back to the point that the Government are closely monitoring the situation with the Bank of England and will be looking at all these issues as we go forward.

Baroness Wilcox of Newport: My Lords, the Government’s decision to cut the universal credit uplift has left hundreds of thousands of extra children in poverty. Following Labour’s lead in reducing the taper rate to allow those on low incomes to keep more of what they earn is indeed a welcome step, but what else are the Government doing to make up for the biggest ever cut to social security, as well as tax hikes and a cost of living crisis?

Baroness Scott of Bybrook: My Lords, our long-term focus for all families remains on continuing to support parents into work and to progress in work. This approach is based on clear evidence of the importance of parental employment. That is where we are putting our investment. Particularly where parents are in full-time employment, it substantially reduces the risk of poverty and improves the long-term outcomes for children. In 2019-20, a child in a home where all adults were working was around six times less likely to be in absolute poverty.

Lord Sentamu: My Lords, I thought the Question from the right reverend Prelate the Bishop of Durham was about the value of the benefits received by families with children, which is where the greatest need is. The Answer he got was that the Government had no plans. What are the reasons for it?

Baroness Scott of Bybrook: I am sorry; I did not quite understand the question. We have no plans to change the two-child policy. I will look in Hansard and, if that is the wrong answer, I will make sure the noble and right reverend Lord gets a written answer.

Lord Reid of Cardowan: The Minister has told us now six times that she is monitoring the situation. That is precisely the problem. What is needed is action, not watching or observing. I well recall a Scotland-England game many years ago where the Scotland goalkeeper, Frank Haffey, monitored the ball going into his net nine times. The point is that he was supposed to stop the ball going into the net. Can the Minister get the Government to do something other than Frank Haffey-ing?

Baroness Scott of Bybrook: My Lords, not long ago, on 3 February, the Government did indeed do something about the cost of living when they announced significant financial support of up to £350 per household to help with energy costs, as well as the energy bills  rebate and £144 million of discretionary funding to local authorities. That is action, not just monitoring; but the monitoring is important.

Pensions: Triple Lock
 - Question

Baroness Bryan of Partick: To ask Her Majesty’s Government what assessment they have made of the impact that the suspension of the triple lock on pensions will have on the lives of pensioners.

Baroness Scott of Bybrook: My Lords, during the passage of the Social Security (Up-rating of Benefits) Act 2021, which suspended the earnings link for state pensions uprating for one year, the Government published an impact assessment. The one-year suspension of the triple lock was in response to the extraordinary economic circumstances at the time, and the Government are committed to applying the triple lock as usual from 2023-24 and for the remainder of this Parliament.

Baroness Bryan of Partick: I thank the Minister for the reply, although telling us that they were looking in their rear-view mirror when making these decisions is not very helpful. We were told at the time that the suspension was justified because 8% inflation was unthinkable. Can the Minister tell us what the inflation rate on household energy is expected to be next month? Can she also perhaps tell us what the inflation rate on budget brands of food is likely to be and, most importantly, how she expects people on state pensions to stay warm and fed?

Baroness Scott of Bybrook: My Lords, I cannot look into a crystal ball and give those figures but they will come out. We know that they are much higher than we ever expected at that time, which is due to global rather than domestic issues. The important thing with this is that the Secretary of State has to undertake an annual review of benefits and pensions, and the CPI in the year to September is the latest figure that they can use to allow sufficient time for the required legislation and operational changes before new rates can be introduced in the new financial year. As I mentioned on a previous Question, because it had to be done at that time, the Government looked at the pressures on the budgets of families and pensioners and made the changes that I spoke about earlier.

Baroness Eaton: My Lords, what are the Government doing to increase the take-up of pension credits?

Baroness Scott of Bybrook: I thank my noble friend for that question because pension credits are important, particularly for very vulnerable pensioners and those on very low incomes. At the moment, there are about 1.4 million people claiming around £5 billion in pension credit but only about 73% of the people who should be taking it up are doing so. The important  thing is that we have to continue to raise awareness. We have put out many letters to pensioners while encouraging them, through the press and social media, to take this up because it is money that is sitting there and should be in their pockets.

Baroness Meacher: My Lords, I fully understand why the Government have had to cancel or suspend the triple lock this year. I also understand that the whole population will take a hit from the inflation increase. I am not sure whether this figure is available but, if it is, can the Minister tell the House what percentage increase in pensions there will be this year, to provide some compensation to pensioners for the huge inflation rate that we all anticipate?

Baroness Scott of Bybrook: I cannot give the figure for that but am very happy to find somebody who can. I will let not only the noble Baroness but the House know it.

Baroness Janke: My Lords, figures show that one in five pensioners in the UK are living in poverty, while 1.3 million retirees are undernourished and 25,000 die each year due to the cold weather. The Minister spoke about extraordinary changes in economic circumstances. Given these and the massive increase in energy costs, what additional support will the Government be providing for pensioners, who suffer particularly when energy costs are high?

Baroness Scott of Bybrook: My Lords, I am conscious that I spoke about households with families before but all the money that the Government are giving for families is available as well to pensioners. The full annual amount of the state pension is worth over £2,300 more in cash terms now than it was in 2010. More than that, about 1.4 million of the most vulnerable pensioners also receive, as we have heard, £5 billion of pension credit. We know it is difficult out there. We are giving money to pensioners through our energy relief costs and living standards costs. We will continue to keep an eye on it and do what we can to increase their budgets.

Lord Mackenzie of Framwellgate: My Lords, it seems to me that this is a perfect storm and I support the noble Baroness, Lady Bryan, in her Question. There is going to be a real reduction in the income of the vulnerable elderly at a time when, on all fronts, the cost of living is going to go through the roof. Can the Minister give some words of comfort to those members of communities who are not just about managing but are manifestly not managing in the autumn of their years and having to choose between eating and heating?

Baroness Scott of Bybrook: Yes, I can. I think it is up to everybody in communities to support our older population in making sure that they are aware of what they can get. There is the basic state pension and, as I said, there is pension credit, but there are also things such as free bus passes, free prescriptions, winter fuel payments and cold weather payments. All these things are available to help the budgets of these very  vulnerable people and it is important—and, I feel, important for the department—to make sure that everybody is getting everything they are entitled to.

Baroness Wheatcroft: My Lords, while many pensioners live on the breadline, quite a few do not and many of those are still in work. Would it not make sense for them to pay the full rate of national insurance and give people who are not in work more help?

Baroness Scott of Bybrook: Of course, they will pay the new rate of national insurance for the National Health Service and social care. I think it is right that they do so if they continue to work, so I agree partly with the noble Baroness.

Baroness Bennett of Manor Castle: My Lords, following up on pension credits, given that the percentage uptake is creeping up very slowly and surveys show that 60% of eligible people who are not receiving it are reluctant to ask for help, is it not time to look again at auto-enrolment? I know this was seen to have failed a decade ago, but digitalisation of records has moved on a lot since then and people should not have to ask—they should just get the money.

Baroness Scott of Bybrook: Yes, I accept what the noble Baroness says and I will take that back to the department. The rate is creeping up; it is at 73% now. We just need to work harder at that as this is money that belongs to those people.

Lord Sikka: My Lords, I would like to debunk the Minister’s statement that somehow the Budget did not permit the Government an increase in pensions, especially as the Government gave a £4 billion tax cut to the bankers. The national insurance fund had a surplus of about £43 billion, more than enough to fund the triple lock. In addition, if the Government had wanted, they could have got more, for example by taxing capital gains at the same rate as earned income and charging national insurance on the same. That would be another £25 billion. Will the Minister admit that the real problem is that the Government are choosing to inflict hardship on our pensioners? It is a political choice, not an economic necessity.

Baroness Scott of Bybrook: No, I do not agree with the noble Lord. For a start, there is no surplus in the fund that can be simply drawn on. The Government Actuary’s Department recommends that a surplus is kept in the national insurance fund to cover day-to-day variations in spend and the surplus is lent to the Government while that happens. It cannot simply be spent again. The money is invested, it is ring-fenced and there is no question of the Government being in a position to use this facility to extract money from the fund as an extra source of revenue.

Lord Davies of Brixton: The Minister quoted what the Government Actuary said. The surplus in the fund will be heading towards 60% but the surplus recommended by the Government Actuary is 16%. That is a difference of more than 40% of the fund. There is the money there.

Baroness Scott of Bybrook: I have no answer to that but I will make sure I get one. I assure noble Lords that the fund cannot be used for the purposes that have been put forward.

Stalking Protection Orders
 - Question

Baroness Royall of Blaisdon: To ask Her Majesty’s Government what steps they are taking to encourage police forces in England and Wales to increase the use of stalking protection orders to safeguard the lives of victims, particularly women.

Lord Stewart of Dirleton: My Lords, we expect all police forces to make full use of stalking protection orders and the Safeguarding Minister has written to chief constables whose forces have not applied for many of them to make that clear. The Home Office is working closely with the National Police Chiefs’ Council’s stalking lead to ensure that these orders are being used appropriately and to establish best practice.

Baroness Royall of Blaisdon: My Lords, an awful lot of letters must have been written because the orders were introduced in 2020. In that year, while 80,000 stalking offences were reported, only 456 stalking orders were issued. In Wales, 7,000 offences were reported and only five orders were issued. The Government said in 2019 that they
“will publish statutory guidance which will help to ensure consistency in their use.”—[Official Report, 18/1/19; col. 471.]
I suggest that there is no consistency. It is a postcode lottery at the moment, and they are used very rarely. A recent Home Office review stated that there was a “lack of training” and insufficient staff and resources. What are the Government doing to address each of those problems? I am glad that the Government are prioritising violence against women and girls, but there seems to be a lack of prioritisation of offences in relation to stalking.

Lord Stewart of Dirleton: My Lords, on actions in relation to enhancing training, I can advise that in 2019 the College of Policing released a set of new advice products. There is a mandatory course for prison offender managers to complete. Within the Crown Prosecution Service, e-learning modules in stalking, harassment and restraining orders are available. The noble Baroness asked how many letters had been sent, although I acknowledge it was partly rhetorical. All chief constables have been written to and, depending on how they were using SPOs, the tenor of the letters has been either to congratulate or to encourage.

Lord Wigley: My Lords, does the Minister accept that the nature of stalking means that individual incidents may seem innocent enough, but it is when a pattern emerges that they become insidious? Does that not mean that the police need specific training to recognise stalking patterns, and that all police forces should have such training tailored and developed so that victims get the help they deserve?

Lord Stewart of Dirleton: I agree wholeheartedly with both parts of the noble Lord’s question. I assure him that such training specifically for police—particularly, and importantly, for first responders—is in place so that the real nature of stalking and the tremendous strains and fear it provokes can be identified at the very outset.

Baroness Newlove: My Lords, the stalking protection orders are very welcome in all matters for victims, and I am grateful to the Suzy Lamplugh Trust for its briefing. However, I am really concerned, as a former Victims’ Commissioner, that we are seeing murky waters. I appreciate that the Safeguarding Minister has sent a letter, but that is to the heads of all these police forces; it is the policemen on the ground who are not adequately trained and are not supporting victims. I say this as I am dealing with two different areas where insufficiently experienced officers are coming out to deal with the severity of the liquids being thrown. Can the Minister go back to the department and see what is happening on the ground? While you are at the top of the league, the bottom is not giving support to victims. The severity of these stalking offences is very important. I hope we are going to address this in the victims’ Bill in the next parliamentary Session.

Lord Stewart of Dirleton: I am very grateful to my noble friend for the question. In part, I refer her to the answer I gave to the previous question. The situation is that there is a degree of independence for individual chief constables to prioritise matters within their own jurisdictions, if I may use that expression. We are seeking to emphasise the real importance of this particular area of law and the real harm inflicted upon victims of stalking, so that it percolates down from the chiefs to the foot soldiers.

Lord McFall of Alcluith: My Lords, I invite the noble Baroness, Lady Brinton, to make a virtual contribution.

Baroness Brinton: My Lords, the Suzy Lamplugh Trust reports that it repeatedly sees police officers trying to apply for other protections, such as non-molestation orders, instead of stalking protection orders. Given that half of stalking cases are not from domestic abuse settings, if you are being stalked by a stranger or a work colleague—not an ex-partner—non-molestation orders would be of no use. What will the Government do to change this? Otherwise, non-domestic stalking cases will continue to be ignored.

Lord Stewart of Dirleton: I gratefully acknowledge the noble Baroness’s question and the terms thereof. The Government are aware that there is a bad practice of applying for the wrong order or for running SPOs in tandem with other matters, including prosecutions. These are aspects of the bad practice that we are seeking to advise against. We are also moving forward with those police forces that are doing exceptionally well—I mention Sussex and Nottinghamshire in those contexts. We are working with police and crime commissioners as well, who are also promulgating good practice through their association.

Baroness Bull: My Lords, in addition to the imposition of restrictions, stalking orders can also include positive conditions, such as requiring offenders to seek mental health treatment or enrol in a drug addiction programme. In this way, they can not only address the horrific impact but help to reduce reoffending. Can the Minister say how many of the 456 orders issued in England and Wales over the last year have included any requirement for this kind of treatment or training?

Lord Stewart of Dirleton: My Lords, I am grateful to the noble Baroness for that question. I am aware, of course, that one of the great values of SPOs is that they can impose positive conditions as well as negative ones. I regret to say that I do not have the specific statistic for which the noble Baroness asked, but if she will permit me, I will write to her with that.

Lord Rosser: My Lords, by what specific criteria will the Government judge whether their intervention with chief constables on stalking protection orders has been successful or unsuccessful, so that we can hold the Government to account?

Lord Stewart of Dirleton: In the first instance, we look at the number of stalking protection orders that are sought and imposed. The figures that I have in relation to their use are encouraging. I can tell the House that 78% of SPO applications in 2021 were granted, compared to only 5% refused, with 17% being dealt with in other ways or withdrawn.

Lord Mackenzie of Framwellgate: My Lords, can the noble and learned Lord advise the House on whether the Crown Prosecution Service has any play in this? Obviously, the police increasingly look to the Crown Prosecution Service for advice, and I wonder whether it has any involvement in this type of decision and whether perhaps it should.

Lord Stewart of Dirleton: The Crown Prosecution Service is involved in training its staff in relation to these matters. Of course, as an independent body, it takes decisions on the prosecution of crime, but in addition the victims of stalking are able to apply, without cost to themselves, for these orders.

Lord Selkirk of Douglas: My Lords, will the Minister accept that his policy to extend it to all police services is very welcome, and that women should be protected at all times against violence or attacks, whatever they may be?

Lord Stewart of Dirleton: I am grateful to my noble friend for this point. Tackling violence against women and girls is a priority for the Government. I am sure that the House will agree that that should be the case. My noble friend is correct to say that there is a universal application of such measures. Scotland has its own distinctive regime, but it is one that deals with the same matter as SPOs in England and Wales.

Lord Russell of Liverpool: My Lords, could I gently take the Minister to task for the accuracy of some of the responses that he has been given in his  brief? If training were in place for all first responders, I really do not think we would be seeing the alarming figures that were issued today for Wales, mentioned by the noble Baroness, Lady Royall. These showed that, out of 7,000 alleged stalking offences, only five SPOs were given. The cost of training an officer fully in the complexity of stalking is £75 per police officer. Will the Government—a combination of the Home Office and the NPCC—get on the backs of every chief constable in England and Wales and get something done? A letter from Rachel Maclean is not enough of itself.

Lord Stewart of Dirleton: First, I acknowledge the interest and hard work which the noble Lord has devoted to this topic. I fully accept that a single letter from the Safeguarding Minister sitting in the other place will not address these matters per se. The figures the noble Lord quotes to your Lordships are indeed worrying. However, I hope that the answers I have been able to give provide some comfort to the House—the noble Lord is shaking his head—as to the seriousness with which the Government take these matters.

Building Safety Bill
 - Order of Consideration Motion

Lord Greenhalgh: Moved by Lord Greenhalgh
That the amendments for the Report stage be marshalled and considered in the following order:
Clause 2, Schedule 1, Clauses 3 to 21, Schedule 2, Clauses 22 to 26, Schedule 3, Clauses 27 to 42, Schedule 4, Clauses 43 to 54, Schedule 5, Clause 55, Schedule 6, Clauses 56 to 106, Schedule 7, Clauses 107 to 115, Schedule 8, Clauses 116 to 124, Schedule 9, Clauses 125 to 138, Schedules 10 and 11, Clauses 139 to 145, Schedule 12, Clauses 146 to 161, Clause 1, Title.
Motion agreed.

Flood Reinsurance (Amendment) Regulations 2022
 - Motion to Approve

Lord Goldsmith of Richmond Park: Moved by Lord Goldsmith of Richmond Park
That the draft Regulations laid before the House on 27 January be approved. Considered in Grand Committee on 10 March.
Relevant document: 29th Report from the Secondary Legislation Scrutiny Committee
Motion agreed.

Health and Care Bill
 - Report (4th Day)

Relevant documents: 15th, 16th and 19th Reports from the Delegated Powers Committee, 9th Report from the Constitution Committee

Amendment 158

Lord Crisp: Moved by Lord Crisp
158: After Clause 164, insert the following new Clause—“Tobacco products statutory scheme: consultation(1) The Secretary of State must, no later than six months after this Act is passed, consult and report on the desirability of making a scheme (referred to in this section and section (Tobacco products statutory scheme: supplementary) as a statutory scheme) for one or more of the following purposes—(a) regulating, for the purposes of improving public health, the prices which may be charged by any manufacturer or importer of tobacco products for the supply of any tobacco products;(b) limiting the profits which may accrue to any manufacturer or importer in connection with the manufacture or supply of tobacco products;(c) providing for any manufacturer or importer of tobacco products to pay to the Secretary of State an amount calculated by reference to sales or estimated sales of those products (whether on the basis of net prices, average selling prices or otherwise) to be used for the purposes of reducing smoking prevalence and improving public health.(2) The consultation must ask for views on a draft statutory scheme (or alternative draft schemes), which may, in particular, make any provision mentioned in subsections (3) to (6).(3) The draft scheme or schemes may provide for any amount representing sums charged by any manufacturer or importer to whom the scheme applies, in excess of the limits determined under the scheme, for tobacco products covered by the scheme to be paid by that person to the Secretary of State within a specified period.(4) The draft scheme or schemes may provide for any amount representing the profits, in excess of the limits determined under the scheme, accruing to any manufacturer or importer to whom the scheme applies in connection with the manufacture or importation of tobacco products covered by the scheme to be paid by that person to the Secretary of State within a specified period.(5) The draft scheme or schemes may provide for any amount payable in accordance with the scheme by any manufacturer or importer to whom the scheme applies to be paid to the Secretary of State within a specified period.(6) The draft scheme or schemes may—(a) prohibit any manufacturer or importer to whom the scheme applies from varying, without the approval of the Secretary of State, any price charged by the manufacturer or importer for the supply of any tobacco product covered by the scheme, and(b) provide for any amount representing any variation in contravention of that prohibition in the sums charged by that person for that product to be paid to the Secretary of State within a specified period.(7) The Secretary of State must lay the report before Parliament and a Minister of the Crown must arrange to make a statement to each House of Parliament setting out in detail any steps which will be taken to implement the findings of the report.”Member’s explanatory statementThis new Clause, along with others, would require the Secretary of State for Health and Social Care to carry out a consultation about a statutory scheme for the regulation of prices and profits of tobacco manufacturers and importers. Funds raised by the scheme would be used to pay for the cost of tobacco control   measures to deliver the Government’s ultimatum for industry to make smoked tobacco obsolete by 2030 and for England to be smoke-free with smoking rates 5% or below.

Lord Crisp: My Lords, I rise to move Amendment 158 and note that the other three amendments in this group are consequential on this one.
These amendments would require the Government to consult on a statutory polluter pays scheme imposed on tobacco manufacturers to fund measures to reduce smoking prevalence and improve public health. In 2019, when the Government announced their smoke-free 2030 ambition, they promised to consider just this sort of polluter pays approach to raising funds for tobacco control. The amendments require the Government to fulfil this commitment by consulting on a statutory scheme and reporting back to Parliament within six months of the Bill’s passage. The scheme consists of two distinct parts: a levy raised from tobacco sales volumes, which would raise an estimated £700 million a year, and a price cap on tobacco products to prevent tobacco companies simply passing these costs on to smokers.
The amendments propose that funding from this scheme be used to pay for the tobacco control measures needed to achieve the smoke-free 2030 ambition. This includes greater investment in stopping smoking services, mass media public education campaigns, targeted support for disadvantaged groups, tackling the sale of elicit tobacco and preventing young people taking up smoking. There are three sets of arguments in this regard, which are all compelling. The first is the impact of tobacco on public health. The second, bluntly, is that this is in line with government policy. The third is the need for a pragmatic approach to where we are today and how we can achieve funding.
Let me just make a few points about the first of those, the impact of tobacco. First, smoking is, of course, the largest single risk factor in ill health and early mortality. Secondly, it is not a lifestyle choice; it may have been originally—as an ex-smoker, I know that—but it is also addictive, and addiction normally starts in childhood. That is why it is really important that we target younger people. Two-thirds of younger people who start smoking carry on into adult life. The current rate of decline is insufficient; smoking prevalence is coming down around the country but, currently, it would take until at least 2047 for the most disadvantaged communities to achieve the level required. Indeed, inequality is a big issue here. Given that so many noble Lords have spoken about inequalities in relation to other amendments to the Health and Care Bill, I just draw out that smoking is responsible for half of the 10-year difference in life expectancy between the richest and poorest parts of society. Whether one smokes or not has a far greater impact on life expectancy than a person’s social position in society.
This is a fundamental health issue—and there are costs. There are costs to the individual: it is estimated that the average smoker spends about £2,000 a year on smoking; and half a million households, a third of a million children and 183,000 pensioners are living in poverty because of the costs of smoking. There are also costs to the system. It is not just about mortality; it is very much about morbidity. We know, for example,  that smokers are more than five times as likely as non-smokers to have microbiologically confirmed influenza and twice as likely to develop pneumonia. Similarly, we know that smokers who quit smoking have better treatment outcomes from day one for everything from cancer to cardiovascular disease, diabetes to dementia, maternity to mental health, stroke to surgery—to the benefit not just of those smokers, but the NHS that provides the service and, frankly, the economy by ensuring that people of working age can be more productive and not take so many days off sick.
Finally, in talking about the impact, I note that there is now enormous public support for these measures. In a recent survey, some 77% of the public supported making tobacco manufacturers pay a levy or licence fee to government for measures to help smokers quit and prevent young people taking up smoking. Nobody in your Lordships’ House will be surprised to know that a levy on tobacco manufacturers has also been endorsed by around 50 health organisations of many different sorts.
As I said at the beginning, there are arguments for these amendments that are about the impact of smoking, which are compelling in themselves. There are arguments that this is fundamentally in line with government policy and that the smoking target will not be hit in 2030 without something of this sort. There is also the very pragmatic argument that in a time of financial difficulty such as this, it is very often the longer-term measures that get cut. There is nothing longer term than making sure that we stop children smoking at an early age. We have, therefore, in this levy a very practical way forward. I beg to move.

Lord Faulkner of Worcester: My Lords, I support Amendment 158 and the others in this group, to which I have added my name. Last Wednesday was national No Smoking Day, and there was an excellent event in a Commons dining room hosted by the All-Party Parliamentary Group on Smoking and Health—I declare an interest as an officer of that group—to celebrate the 50th anniversary of ASH. The star speaker was the Public Health Minister, Maggie Throup. She reaffirmed the Government’s commitment to achieving a smoke-free England by 2030 and rightly said that stop-smoking services would be at the centre of the forthcoming tobacco control plan.
NICE has estimated that, for every £1 invested in stop-smoking services, £2.37 will be saved on treating smoking-related diseases and reduced productivity. However, cuts to local public health budgets have disproportionately hit stop-smoking services. They have lost a third of their funding in real terms since 2015, accompanied by a decline in the number of smokers setting quit dates.
If the Government truly want stop smoking services to be at the centre of the tobacco control plan, these funding cuts must be reversed. The spending review did not reverse the cuts and the levelling up White Paper has also not provided the additional funding. But these amendments, based on a polluter pays levy, could do the job the Government say they want to achieve. The polluter pays levy could also pay for  other vital measures, because smoking is an addiction and to overcome that addiction, smokers need to be motivated to quit.
In the States, a mass media campaign called Tips from Former Smokers is funded by a levy on manufacturers. Over a six-year period, the campaign increased the number of successful quitters by 1 million; it was equally effective with ethnic minorities and smokers with poor mental health, and had healthcare cost savings of $11,400 per lifetime. All those people quit as a result of that campaign. In England, funding for mass media campaigns, which was at US levels in 2009, fell by 90% to only £2 million in 2019. This was matched by a 25% decline in the proportion of adult smokers in England who tried to quit in the previous year. If smokers do not try to quit, they cannot succeed.
I commend to the House the words of the chair of the Government’s independent review of smoking, Javed Khan. Speaking to the Times last week, he said:
“Just look at the Covid experience, mass marketing has a big effect, it really works. The Government went hell for leather, it made an enormous difference in vaccination rates. So why not do something like that again, if we really want to save people’s lives.”
We agree, but the funding must be found, and the best and most realistic option is for the polluter—that is, the tobacco companies—to be made to pay. I support these amendments.

Lord Young of Cookham: My Lords, it is a pleasure to follow the noble Lords Lord Crisp and Lord Faulkner in support of these amendments, which replicate the amendment I moved in Committee. They set out proposals for a statutory smoke-free 2030 fund, based on the polluter pays principles, to pay for measures to end smoking. We are grateful to both Ministers for the time that they spent with us on a Zoom call last week, when we sought to persuade them of the merits of these amendments, and time alone will tell whether those representations bore fruit.
In Committee, my noble friend Lord Naseby, whom I see in his place, suggested that these proposals had been consulted on in 2015, and that the Government had concluded they were not workable, a conclusion which he said had been reiterated by the Exchequer Secretary on 10 January 2022. While my noble friend was right to say that the Government consulted on the levy in 2015, they did not consult on the proposals before us today. What was consulted on then was an additional tax, and the decision was taken not to proceed because tobacco manufacturers and importers would pass the costs of a levy on to consumers; the Statement by the Treasury in January merely reiterated that conclusion. Back in 2015, the regulation of tobacco prices to prevent the costs of a levy being passed on to consumers was prohibited by the rules of the European Union. That is no longer the case, so the 2015 objection to the levy no longer holds true. The Government can now put the financial burden firmly where it belongs, on the polluter—the tobacco manufacturer— and not the polluted—the smoker.
Our scheme enables the Government to limit the ability of manufacturers to profit from smokers, while protecting government excise tax revenues, which is a win-win for the Government and for smokers. The  scheme is modelled on the Pharmaceutical Price Regulation Scheme, the PPRS, which has been in operation for over 40 years and is overseen by the Department of Health and Social Care. It has teams of analysts who already have the skills to administer a scheme for cigarettes, a much simpler product to administer than pharmaceutical medicines.
Unlike corporate taxes, which are based on reported profits and can be—and indeed are—evaded, the levy would be based on sales volumes, as is the case in America, where a similar scheme already operates. Sales volumes are much easier for the Government to monitor and much harder for companies to misrepresent. Implementing a levy would not require a new quango to be set up, as the Department of Health and Social Care has all the expertise needed both to supervise the scheme and to allocate the funds raised. We would not be averse to the consultation mentioned in the amendment including other options, as long as it included careful consideration of our proposals.
The Government have said that they accept the polluter pays principle. My party has form in implementing that proposal through the landfill levy, the tax on sugar in soft drinks and requiring developers to pay for the costs of remediating building safety defects. Indeed, as we heard from the noble Lord, Lord Crisp, the Government promised to consider this approach to funding tobacco control nearly three years ago in the prevention Green Paper. Surely they should now welcome this opportunity to consider how it can be put into practice.

Lord Rennard: My Lords, I speak in support of these amendments, to which I have added my name, and which are in accordance with my party’s policy.
In Committee, there was almost universal support for dealing with health inequality issues, and there was widespread recognition that, as the noble Lord, Lord Crisp, said, half the difference in life expectancy between the richest and the poorest people in this country is caused by smoking. There are many ways in which we can further reduce the prevalence of smoking, and those of us who are members of the APPG on Smoking and Health set them out during the course of our debates.
However, we are concentrating today on just one key principle which is necessary if the Government’s target of reducing the prevalence of smoking to 5% or below is to be achieved by 2030. That principle is finding the funds to support smoking cessation and tobacco control measures through a levy on the tobacco companies. This would help to ameliorate the terrible damage done by their products, which includes shortening the lives of half the people who use them.
The funding for local authorities to pursue tobacco control policies such as smoking cessation services and enforcement and for national mass media campaigns has been cut significantly. Without the proposed levy, the NHS will face greater costs in future in dealing with the many issues, such as lung cancer and heart disease, which arise in part because of smoking tobacco.
Last month, together with other officers of the APPG on Smoking and Health, I had the pleasure of meeting Javed Khan, chair of the Government’s independent review into smoking. He listened carefully  to all our proposals, particularly on the levy, and certainly understood the necessity of funding being found. The Government have asked him to say what the most impactful interventions that could be taken forward in the new tobacco control plan would be. He told us that if nothing different is done, the Government’s smoke-free target will not be met. He promised that his recommendations would be “bold and brave”, as I hope they will.
I expect that we will soon get some soothing words from the Minister. But before he replies to this debate, I ask him to consider how, in “Hamlet”, King Claudius has to admit that
“words without thoughts never to heaven go”.
I hope the Minister will give us not just warm words about tobacco control but confirm that the Government have thought about the tobacco levy and will undertake a formal consultation on it.

Lord Naseby: My Lords, I hasten to say to your Lordships that I do not smoke and have never smoked. In considering the amendments before us this afternoon, it is worth giving some of the official statistics rather than the aspirational ones. Smoking rates in England continue to decline year on year and that has been a trend for the last 30 years. According to the Office for National Statistics in 2021, smoking rates in England have declined significantly, from 20% in 2011 to 12% in 2020. The decline in the number of smokers has resulted in a reduction in the cost to the NHS of treating the impact of smoking. In 2015, Public Health England estimated that the total smoking-related cost to NHS England was £2.6 billion a year, when 18% of the population smoked. This figure and the corresponding cost to NHS England over the last five years have declined further, given the 12% smoking rate in England in 2020. According to NHS data published in 2019 on smoking, drinking and drug use among young people, the number of young people aged 11 to 15 smoking has declined dramatically, from 16% to just 5% in 2018. According to the Office for National Statistics in 2021, only 12% of 18 to 24 year- olds in Great Britain smoke, a major reduction from 26% in 2011 and the lowest smoking rate across all age groups except the over-65s.
By way of background, according to the most recent HMRC tax gap data, illegal smuggling and consumption of illicit tobacco cost Her Majesty’s Government £2.3 billion in lost revenue in 2019-20, a figure that remains unchanged from the fiscal year 2016-17, which reinforces the fact that the Government’s anti-illicit tobacco strategy is not working. It ought to be working, when you have a situation where a group of companies is working with the Department for Health and has done over many years. Frankly, it is a sad reflection on the status of HMRC that this illicit tobacco importation is increasing. You have only to look at what is happening in Dover or any of our other ports today to see why it is increasing. It is a pathetic and embarrassing performance at Dover at the moment, the net result being not just tobacco but illegal alcohol and so on coming in.
Now we look at the idea of a levy, something that has never been in the manifesto of a Conservative Government to the best of my knowledge. A levy on any company prescribed by government, even companies  trading locally, certainly does not fit into the basic elements of our financial and economic strategy. If it was just a levy on cigarettes, there might be half a case, but this is on anything to do with tobacco. Most of all those other products have no effect on people’s health—they are a matter of enjoyment—but this idea goes across the whole lot. It has not been thought through.
It is all very well my noble friend Lord Young on the Back Benches saying that there was a consultation in 2015 on a levy on tobacco manufacturers’ profits and the Government concluded that it would be unworkable, but that was because we were in the EU so it has all changed now. I say to my noble friend on the Front Bench: I would have thought he had enough on his hands without introducing a complicated levy, but that is my personal view. There was an exchange between the Exchequer Secretary and the then shadow Exchequer Secretary, confirming
“that our position regarding the 2015 consultation stands. A levy would be a complex”—
this is not going to change—
“and costly way of raising money to fund tobacco control measures and would be unlikely to provide a stable revenue stream.”
I say to my noble friends on all sides of the House that tobacco manufacturers already invest hundreds of millions of pounds every year in R&D and highly skilled jobs to bring to market alternative smoke-free nicotine products. Some of your Lordships may use e-cigarettes, nicotine pouches or heated tobacco products. Further tax increases on manufacturers as a whole will have the effect of reducing that investment, which is not a very clever way forward.
The introduction of a levy additionally would represent only a further punitive tax on a legitimate legal product and would unfairly have a direct impact on consumers who have made an informed choice to smoke and are fully aware of the risks associated with smoking. The Government already have two tools to raise money from tobacco: excise and MET—minimum excise tax—which could be used much more efficiently.
Frankly, the chief beneficiaries of the levy will be those criminals who supply and trade in illegal counterfeit and contraband tobacco, as more consumers are pushed away from being able to afford legitimate tobacco products. We see that today—it is happening this very hour. The introduction of a profit cap on individual companies, as suggested by some pressure groups and the signatories to these amendments, is entirely inappropriate and anti-business for a highly competitive consumer goods industry with a growing range of innovative products that are already heavily taxed and highly regulated.
My noble friend raised in evidence the PPRS. That was dropped by a former Government because as far as they were concerned it was not working. The pharmaceutical dimension of the Department of Health brought in NICE instead, so my noble friend is not right to call in the PPRS as an example of a success.
The introduction of the profit cap is in my judgment entirely inappropriate and anti-business for this highly competitive goods industry. To conclude, it would send out an extraordinarily negative signal that the  UK is hostile to business at exactly the time it is trying to position itself as a leading destination for global investments, enterprise and economic growth. Existing taxes on tobacco products are already among the highest in the world, accounting for over 90% of the price of cigarettes. Again according to HMRC’s figures, the Government collected £12.5 billion in excise and VAT from tobacco products in 2020.
I say to my noble friend on the Front Bench that I understand that the Government are bringing forward their tobacco control proposals, and of course we will look at those carefully. However, as someone who comes from a medical household, I know that other parts of the health service urgently need attention. The whole of the GP practice situation in our country is in very deep trouble at the moment and that is where the money should be spent, not on trying to administer some marginal levy system which will not work and will cost Her Majesty’s Government a fortune.

Baroness Northover: My Lords, briefly, I support these amendments; my name was on an amendment at an earlier stage. I hope that the Minister will have managed to persuade other parts of government that they will not achieve a smoke-free 2030 in the UK unless they move further and faster on tackling an industry built on promoting ill health and death—the reverse of what the health service seeks to do.
The Department of Health has come a long way in this area, with much cross-party working, and I know that the noble Earl himself has been part of that cross-party support in tackling the terrible health consequences of smoking. I have a sense of déjà vu, as I think others might. Over the years, the noble Lord, Lord Naseby, has been a rather lone voice on the other side. From time to time FOREST, which makes it plain that it is funded by the tobacco industry, kindly sends me its brief, no doubt inadvertently, and I recognise some familiar phrases that have just been voiced. I noted the rueful expression of the noble Lord, Lord Naseby, as the noble Lord, Lord Young, took apart what he had said about the levy.
The Government say that they are committed to delivering a smoke-free 2030, but keep putting off the action required. Not all parts of government are fully aligned to this in the actions taken. The steps proposed in the amendments are designed to help the Government achieve what they say they wish to do. I therefore commend them to the House.

Lord Stevens of Birmingham: My Lords, I want to make just a small factual supplement to the contribution from the noble Lord, Lord Naseby. In fact, it was a Conservative Government in 1957 who introduced the pharmaceutical price regulation scheme or PPRS, and that scheme has been sustained ever since by Conservative, Labour and coalition Governments. As the noble Lord, Lord Young, pointed out, if it is deemed appropriate to have a form of price and profit regulation for the medicines industry, which delivers products that are essential and life-saving, it does not seem too far a stretch to think that an equivalent mechanism might be used for an industry whose products are discretionary and life-destroying.

Lord Lansley: My Lords, I was not intending to intervene, but I was prompted to do so not least by the noble Lord, Lord Stevens of Birmingham. That the PPRS has been sustained by Governments, albeit amended from time to time, should not lead us to the conclusion that all products should have their pricing and regulation controlled by government. I do not think that the analogy runs at all, so we should ignore the PPRS for these purposes.
My noble friend on the Front Bench whom I believe is replying to this debate and I were in a coalition Government with the noble Baroness, Lady Northover, and we were pretty clear then. I remember a decade ago creating a bit of a storm by saying that I wanted to end up with a smoke-free England. We have reached a point now where there are tobacco companies which think that we are going to arrive at that position, and so we should. I do not think that this debate is about whether we achieve that; it is about the mechanisms by which we do so.
If my noble friend reiterates the Government’s intention, willingness and sense of urgency about bringing forward measures, as I hope he does, I would not bind the hands of the Government with these amendments. Frankly, even if they were passed, nothing would happen unless and until the Government bring forward legislation for the purpose. It would be better for us to have the debate and make the position clear. I do not disagree with the arguments presented by the noble Lord, Lord Crisp, and others—when we were in government, we implemented things such as the ban on display in shops and preventing the availability of cigarettes to youngsters through vending machines, which I think was one of the most important things we could do. We made progress; we need to make more. We need the Government to come forward with proposals for that, but these amendments are not necessary if the Government say that they are willing to make progress.

Baroness Fox of Buckley: My Lords, I was not intending to speak, but I wanted to counter the point made to the noble Lord, Lord Naseby, that he was simply rehearsing lines from FOREST, the pro-freedom to smoke group. I also inadvertently receive communiques from ASH, the anti-smoking lobby group—I think it has me muddled up with someone else—and I have heard many of its lines rehearsed here as well on the other side of the argument. I thought it might be worth noting that.
Secondly, I have to declare an interest: I smoke. I appreciate that this means that I am beyond any redemption —goodness knows, I am controversial enough on a range of other things, but that is probably the worst.

A noble Lord: Hear, hear!

Baroness Fox of Buckley: Well, good. I have got a few “hear, hears”.

Lord Rennard: Does the noble Baroness accept that a crucial difference is that organisations such as ASH are funded by organisations concerned with public health, including Cancer Research UK and people who deal with trying to save lives, while FOREST is funded by the tobacco industry, which kills half its customers?

Baroness Fox of Buckley: I was coming on to that point. I would really appreciate a dose of honesty in this House. If those people who are so hostile to smoking a legal product believe that it is the killer they allege, they should call for smoking to be made illegal and be done with it. At the moment, tobacco companies are legal companies. People talk about them with such distaste, as though they should be abolished. It would be better and more heartfelt if they argued that tobacco should be illegal; then we would have a different debate. Public health is not always neutral when you talk about public health lobbyists, in my opinion. The freedom to choose to do something that is bad for your health is still allowed in a free society, despite some people wishing it was not.

Baroness Walmsley: My Lords, I do not recall anybody suggesting in the debate that tobacco companies should be made illegal. I hope that the noble Lord, Lord Naseby, is not suggesting that, just because the number of smokers is going down, nothing more should be done. I thought I heard the noble Lord, Lord Crisp, suggest that, if we carry on at this rate, it will be another 25 years before we get to where we need to be.

Lord Naseby: I was suggesting that we do carry on because the evidence is there in government data, not in a forecast from the noble Lord, Lord Crisp, or some minor operation that he—

Baroness Penn: I remind noble Lords that only short questions of elucidation are allowed on Report.

Baroness Walmsley: Many thanks. I suggest to the noble Lord, Lord Naseby, that a lot more people will be dead from tobacco if we carry on at this rate. He suggested that, just because this measure was not in the Conservative Party’s manifesto, perhaps we should not carry it forward. Well, the Conservative Party does not have all the best ideas, although I congratulate the Government on the sugary drinks levy, which has been highly successful. We support the polluter pays amendment introduced by the noble Lord, Lord Crisp. I might call it the killer pays amendment because, make no mistake, this is a killer substance.
I happen to live in Wales so I want to raise a matter that has not been mentioned yet. I am glad that the Welsh Government have committed to a smoke-free Wales by 2030. However, although England announced its intention to go smoke-free by 2030 two years before Wales did, Wales has leapt ahead as regards action, which is why I hope that the Minister will either accept Amendment 158 or give adequate assurances. In the Green Paper of July 2019, the Government said:
“Further proposals for moving towards a smoke-free 2030 will be set out at a later date.”
Approaching three years later, still nothing has happened. There are no further proposals and no funding has been announced. In contrast, Wales has published concrete proposals, but many of the interventions require action from the UK Government. Examples include the polluter pays funding mechanism, which could help to fund tobacco control in Wales; raising  the age of sale; and putting warnings on cigarettes and pack inserts. I am concerned that, by being so slow, the UK Government are undermining the ability of the devolved Administrations to achieve their smoke-free ambitions. We will support the noble Lord, Lord Crisp, if he chooses to put this amendment to a vote.

Baroness Merron: My Lords, I am grateful to noble Lords for their contributions to this debate and for putting forward this group of amendments. In introducing Amendment 158 and the consequential amendments, the noble Lord, Lord Crisp, outlined that they would establish a consultation on a polluter pays levy whereby funds are raised by the scheme to pay for the cost of tobacco control measures to deliver a smoke-free 2030. This strikes me as wholly pragmatic; a wide-ranging consultation would undoubtedly help to strike the right balance between all the parties involved.
We know from this debate and many previous debates that tobacco use carries huge health risks, and disproportionately so for the most disadvantaged in society, whose likelihood of smoking is four times higher in the most deprived areas compared to the least deprived. If ever there was a case for levelling up, this is it. My noble friend Lord Faulkner rightly highlighted that we have seen cuts to stop-smoking services, and this group of amendments seeks to redress the situation in a practical way. It is vital that we motivate and support more smokers to quit, while reducing the numbers of children and young people who start to smoke. Greater action is clearly needed now.
The scheme proposed in this group of amendments would provide a well-funded and much-needed boost, and a consultation would allow this proposal to be tested, refined and shaped. I hope that the Minister will accept the opportunity of a consultation but if the will of the House is tested, these Benches will support the amendments.

Earl Howe: My Lords, I am grateful to all noble Lords who have spoken in this debate and in the informative debate we had in Committee, on which I have reflected carefully. Let me first remind the House of what we are doing in this area.
We are committed to making England smoke free by 2030 and will set out our approach in a new tobacco control plan to be published later this year. As part of that work, we are exploring a number of regulatory proposals and have launched an independent review into smoking. The review, led by Javed Khan OBE, will make a set of focused policy and regulatory recommendations to government on the most impactful interventions to reduce the uptake of smoking and support people to stop smoking for good. It is in that context that I turn to the detail of these amendments.
As mentioned in previous debates, while I speak for the Government as a whole, tobacco taxation matters are ones for Her Majesty’s Treasury. As noble Lords will know, the tobacco industry is already required to make a significant contribution to public finances through tobacco duty, VAT and corporation tax. Through these finances we are able to fund local authority stop-smoking services through the public health grant  and provide extra resources as part of the NHS long-term plan commitment to help smokers quit. As part of the annual Budget process, Her Majesty’s Treasury will continue the policy of using tax to raise revenues and encourage cessation through continuing with above-RPI duty increases on tobacco products. It is a proven and effective revenue-raising system.
I am as keen as anyone to find new ways in which to bear down on the prevalence of smoking and I am proud to have been instrumental in bringing some about. However, I am afraid that I cannot accept the amendment as it stands. The proposal may look simple on the surface but it is complex to implement. It may also take several years to materialise. Our strong preference is to continue with high tobacco taxation and excise as the best means and the most efficient process through which to generate revenue that can be put back into public services. However, I can tell the noble Lord, Lord Crisp—I hope that this will at least be of some reassurance to him—that the department’s officials will continue to work with Her Majesty’s Treasury to explore whether there are other innovative financing models that can be applied to the tobacco industry to support Smokefree 2030 and be as effective and efficient as the current taxation system. It may be—I do not know —that Javed Khan will come forward with recommendations in this area. We should allow him the necessary time to conduct his independent review.
I realise my reply will be disappointing to the noble Lords, Lord Crisp and Lord Faulkner, and my noble friend Lord Young, who are understandably passionate about this issue. I hope they will realise that we are very much on the same page regarding the overriding objective to reduce and eliminate the practice of smoking in this country. I hope I have provided some reassurance that the Government have listened and thought carefully about this proposal, even if we have not felt it right to proceed with it, in the end. As the noble Lord, Lord Crisp, would expect, we will set out our financial plans to support smoke-free 2030 in our new tobacco control plan. For those reasons, I ask him to withdraw his amendment.

Lord Crisp: My Lords, first, I thank those noble Lords who added their names to this amendment and spoke so eloquently in this debate, which covered a range of important issues that between them present a compelling argument for what is only a consultation. Secondly, I thank the other noble Lords who spoke during the debate, including those who spoke against the amendment, because having a proper debate allows us to pull out some important issues. I will return to that in a moment. Thirdly, I thank the Minister for the time that he and his colleagues gave to meet with us, and for our helpful discussions. I very much accept the noble Earl’s statement about us being on the same side and pushing in the same direction, but we need to get there.
That takes me to picking up some of the points that were made. I thought the contribution from the noble Lord, Lord Naseby, was very helpful. The point he made about how the numbers are coming down was terrific. It is great news—so let us accelerate it. We can get behind that and really shift it. There is a problem here, as with so much in public health, in that people  talk about aggregates and averages. There is a real trap in aggregates and averages. The aggregate could come down to 5%, but 20% of people in the lowest socio- economic group could still be smoking. That is the problem when you deal in gross numbers. I said in the debate that, according to Cancer Research UK, which is a reasonably reputable body, it would be 2047 before we saw that level of achievement among the lowest socioeconomic group in the country. Aggregates and averages are real traps in public health.
I understand the good faith of the Ministers in this House. However, and I think I speak for my colleagues on this amendment, we note that the Green Paper in 2019 promised to consider the idea of polluter or perpetrator pays—whatever is the right language for that. Almost three years on, we have not yet seen that happen. Not surprisingly, we are rightly suspicious of how these things can be kicked into the long grass and continue for a long time. If we are to achieve the 2030 outcomes for all the people for whom we want to achieve them, we need to accelerate. I believe the proposals put forward here are practical and implementable, as the noble Lord, Lord Young, spelled out.
In our discussions with Ministers, we offered a number of concessions, including the idea that it did not have to be precisely this scheme that was implemented, as they could consult on others. I am sorry the Government have been unable to accept that. On the basis of everything that has been said today, I would like to test the opinion of the House.
Ayes 213, Noes 154.

Amendment 158 agreed.

Amendments 159 to 161

Lord Crisp: Moved by Lord Crisp
159: After Clause 164, insert the following new Clause—“Tobacco products statutory scheme: supplementary(1) The Secretary of State may make any provision he or she considers necessary or expedient for the purpose of enabling or facilitating—(a) the introduction of a statutory scheme of the type mentioned in section (Tobacco products statutory scheme: consultation), or(b) the determination of the provision to be made in a proposed statutory scheme.(2) The provision may, in particular, require any person to whom such a scheme may apply to—(a) record and keep information;(b) provide information to the Secretary of State in electronic form.(3) The Secretary of State must—(a) store electronically the information which is submitted in accordance with this provision;(b) ensure that information submitted in accordance with this provision is made publicly available on a website, taking the need to protect trade secrets duly into account.(4) Where the Secretary of State is preparing to make or vary a statutory scheme, he or she may make any provision he or she considers necessary or expedient for transitional or transitory purposes which could be made by such a scheme.”
160: After Clause 164, insert the following new Clause—“Tobacco products statutory scheme: enforcement(1) The provisions of this section apply if, following consultation under section (Tobacco products statutory scheme: consultation), legislation is enacted which enables the making of a statutory scheme.(2) Regulations may provide for a person who contravenes any provision of the scheme, including any regulations or directions made under the scheme, to be liable to pay a penalty to the Secretary of State.(3) The penalty may be—(a) a single penalty not exceeding £5 million;(b) a daily penalty not exceeding £500,000 for every day on which the contravention occurs or continues.(4) Regulations may provide for any amount required to be paid to the Secretary of State by virtue of any provision in the scheme reflecting section (Tobacco products statutory scheme: consultation) (4) or (6)(b) to be increased by an amount not exceeding 50 per cent.(5) Regulations may provide for any amount payable to the Secretary of State by virtue of any provision in the scheme reflecting section (Tobacco products statutory scheme: consultation) (3), (4), (5) or (6)(b) (including such an amount as increased under subsection (4) of this section) to carry interest at a rate specified or referred to in the regulations.  (6) Provision may be made by regulations for conferring on manufacturers and importers a right of appeal against enforcement decisions taken in respect of them in pursuance of the scheme, section (Tobacco products statutory scheme: consultation), (Tobacco products statutory scheme: supplementary), and this section.(7) The provision which may be made by virtue of subsection (6) includes any provision which may be made by model provisions with respect to appeals under section 6 of the Deregulation and Contracting Out Act 1994, reading—(a) the references in subsections (4) and (5) of that section to enforcement action as references to action taken to implement an enforcement decision, and(b) in subsection (5) of that section, the references to interested persons as references to any persons and the reference to any decision to take enforcement action as a reference to any enforcement decision.(8) In subsections (6) and (7), “enforcement decision” means a decision of the Secretary of State or any other person to—(a) require a specific manufacturer or importer to provide information to him or her,(b) limit, in respect of any specific manufacturer or importer, any price or profit,(c) refuse to give his or her approval to a price increase made by a specific manufacturer or importer, or(d) require a specific manufacturer or importer to pay any amount (including an amount by way of penalty) to him or her,and in this subsection “specific” means specified in the decision.(9) A requirement or prohibition, or a limit, under section (Tobacco products statutory scheme: consultation), may only be enforced under this section and may not be relied on in any proceedings other than proceedings under this section.(10) Subsection (9) does not apply to any action by the Secretary of State to recover as a debt any amount required to be paid to the Secretary of State under section (Tobacco products statutory scheme: consultation) or this section.(11) The Secretary of State may by order increase (or further increase) either of the sums mentioned in subsection (3).”
161: After Clause 164, insert the following new Clause—“Tobacco products statutory scheme: controls: supplementary(1) The provisions of this section apply if, following consultation under section (Tobacco products statutory scheme: consultation), legislation is enacted which enables the making of a statutory scheme.(2) Any power conferred on the Secretary of State by legislation enacted which enables the making of a statutory scheme, and by section (Tobacco products statutory scheme: supplementary) may be exercised by—(a) making regulations, or(b) giving directions to a specific manufacturer or importer.(3) Regulations under subsection (2)(a) may confer power for the Secretary of State to give directions to a specific manufacturer or importer; and in this subsection “specific” means specified in the direction concerned.(4) In this section and sections (Tobacco products statutory scheme: consultation), (Tobacco products statutory scheme: supplementary) and (Tobacco products statutory scheme: enforcement)—“tobacco product” means a product that can be consumed and consists, even partly, of tobacco;“manufacturer” means any person who manufactures tobacco products;  “importer” means any person who imports tobacco products into the United Kingdom with a view to the product being supplied for consumption in the United Kingdom or through the travel retail sector, and contravention of a provision includes a failure to comply with it.”
Amendments 159 to 161 agreed.

Amendment 162

Lord Hunt of Kings Heath: Moved by Lord Hunt of Kings Heath
162: After Clause 164, insert the following new Clause—“Appropriate consent to transplantation activities when travelling abroad(1) Section 32 of the Human Tissue Act 2004 (prohibition of commercial dealings in human material for transplantation) is amended in accordance with subsections (2) to (6).(2) In subsection (1), after paragraph (e) insert—“(f) travels outside the United Kingdom to a country or part of a country where explicit consent is not required for the legal donation of controlled material which does not meet the criteria in subsection (1A)(a) to (c) and receives any controlled material, for the purpose of transplantation, without—(i) the free, informed and specific consent of a living donor, or(ii) the free, informed and specific consent of the donor’s next of kin, where the donor is unable to provide consent;(g) travels outside the United Kingdom to a country or part of a country where explicit consent is required for the legal donation of controlled material and receives any controlled material for the purpose of transplantation where the material was obtained without—(i) the free, informed and specific consent of a living donor, or (ii) the free, informed and specific consent of the donor’s next of kin, where the donor is unable to provide consent;(h) travels outside the United Kingdom to a country or part of a country and receives any controlled material for the purpose of transplantation for which, in exchange for the removal of controlled material—(i) the living donor, or a third party, receives a financial gain or comparable advantage, or(ii) where the controlled material comes from a deceased donor, a third party receives financial gain or comparable advantage.”(3) After subsection (1) insert—“(1A) The Secretary of State must publish an annual assessment of countries where, explicit consent is not required for the legal donation of controlled material, determining whether each of those countries—(a) provides a formal, publicly funded scheme for opting out of deemed consent for donation of controlled material,(b) provides an effective programme of public education to its population on the deemed consent system and the opt-out scheme which delivers a high level of public understanding of both, and(c) is not considered to be committing Genocide by resolution of the House of Commons.(1B) In paragraph (h) in subsection (1), the expression “financial gain or comparable advantage” does not include compensation for loss of earnings and any other justifiable expenses caused by the removal or by the related medical examinations, or compensation in case of damage which is not inherent to the removal of controlled material.  (1C) Subsection (1E) applies if—(a) an act which forms part of an offence under subsection (1) takes place outside the United Kingdom, but(b) the person committing the act has a close connection with the United Kingdom.(1D) For the purposes of subsection (1C)(b), a person has a close connection with the United Kingdom if, and only if, the person was one of the following at the time the acts or omissions concerned were done or made—(a) a British citizen;(b) a British overseas territories citizen;(c) a British National (Overseas);(d) a British Overseas citizen;(e) a person who under the British Nationality Act 1981 was a British subject;(f) a British protected person within the meaning of that Act;(g) an individual ordinarily resident in the United Kingdom;(h) a body incorporated under the law of any part of the United Kingdom;(i) a Scottish partnership.(1E) Where this subsection applies, proceedings for the offence may be taken in any criminal court in England and Wales or Northern Ireland.”(4) In subsection (3), after “subsection (1)” insert “(a) to (e)”.(5) In subsection (4), after “subsection (1)” insert “(a) to (e)”.(6) After subsection (4) insert— “(4A) A person guilty of an offence under subsection (1)(f) to (h) shall be liable—(a) on summary conviction—(i) to imprisonment for a term not exceeding 12 months,(ii) to a fine not exceeding the statutory maximum, or(iii) to both;(b) on conviction on indictment—(i) to imprisonment for a term not exceeding 9 years,(ii) to a fine, or(iii) to both.”(7) In section 34 of the Human Tissue Act 2004 (information about transplant operations), after subsection (2) insert—“(2A) Regulations under subsection (1) must require specified persons to—(a) keep patient identifiable records for all instances of UK citizens who have received transplant procedures performed outside the United Kingdom; and(b) report instances of transplant procedures performed on UK citizens outside the United Kingdom to NHS Blood and Transplant.(2B) Regulations under subsection (1) must require NHS Blood and Transplant to produce an annual report on instances of UK citizens receiving transplant procedures outside the United Kingdom.””Member’s explanatory statementThe amendment is aimed at ensuring that in relation to organ tourism, there must be informed consent with no coercion or financial gain for the donation of organs. Thus prohibiting organ tourism which involves either forced organ harvesting or black market organ trafficking.

Lord Hunt of Kings Heath: My Lords, this was debated two weeks ago, but I know that the noble Earl, Lord Howe, wishes to say a few brief words to your Lordships’ House. With the permission of the  House, I will say very briefly, without seeking to open the debate, what the amendment does. It is to amend the Human Tissue Act to prohibit UK citizens from travelling to countries such as China, although the wording in the amendment is not country-specific, for the purpose of organ transplantation. The restrictions are based on ensuring that there is appropriate consent, no coercion and no financial gain.
Forced organ harvesting in China is the crime of forcibly extracting organs from prisoners of conscience, killing the victim in the process. The harvested organs are sold to Chinese officials, Chinese nationals or foreigners for transplantation. This is a very modest amendment, doing our bit to try to prevent this obnoxious habit. I beg to move.

Earl Howe: My Lords, I am very grateful to the noble Lord, Lord Hunt, for allowing me to say in a few sentences why the Government advise noble Lords not to support the amendment.
Reason number one is the effect on patients. In my submission, very sick patients who may be taken overseas for a transplant but are not fully made aware of how their organ was sourced should not have to face prosecution when they return to the UK. The existing legislation rightly targets those who buy and sell organs, not recipients who may have been quite unaware of any commercial dealing taking place. If we target the organ recipient, we will find that those who legitimately receive organs overseas—incidentally, individuals who are more likely to come from ethnic-minority backgrounds—will be deterred from seeking follow-up treatment for fear of being treated like a criminal suspect.
Reason number two is that the mischief the amendment seeks to address is dwarfed by the considerable burdens it would impose on the NHS. All the information indicates that we are dealing, at worst, with tiny numbers of illegal transplants performed overseas. The amendment would require officials, whose focus should be on promoting legitimate donation, to research and write a report every year on the status of every other deemed consent system in the world and on the public understanding of each scheme. That is not a drafting criticism but a necessary consequence of what the noble Lord seeks to achieve. In my view, it is an unreasonable ask and a hugely disproportionate use of resources.
To address the issue at first base, we will take forward the excellent suggestion from the noble Baroness, Lady Finlay, to work with NHS Blood and Transplant. My noble friend Lord Kamall has already instructed officials to engage with it on how we can help clinicians make their patients aware of the health risks, the risk that they may be exploiting others and the risk of breaking the law if they travel abroad in search of an illegitimate transplant. I truly think that is a better way forward, and I invite the noble Lord to change his mind about pressing his amendment.

Lord Hunt of Kings Heath: My Lords, I will not detain the House. It is time for the House to make a decision. I am very grateful to the Minister for picking up the point made by the noble Baroness, Lady Finlay, in relation to NHS Blood and Transplant.  In the end, it may be a small gesture but it is an important gesture—a mark against this obnoxious habit. I would like to test the opinion of the House.
Ayes 203, Noes 159.

Amendment 162 agreed.

Amendment 163

Baroness Finlay of Llandaff: Moved by Baroness Finlay of Llandaff
163: After Clause 164, insert the following new Clause—“Alcohol labelling(1) The Secretary of State must, no later than one year after this Act is passed—(a) publish a report on alcohol labelling, assessing which elements should be mandatory on labels to improve consumer knowledge, and this should include, but not be limited to—(i) warning about alcohol harms,(ii) calorific and other nutritional information,(b) lay the report before Parliament, and a Minister of the Crown must arrange to make a statement to each House of Parliament setting out any steps which will be taken to implement the findings of the report.”Member’s explanatory statementThis amendment requires the Secretary of State to publish a report on alcohol labelling to improve consumer knowledge.

Baroness Finlay of Llandaff: My Lords, we now come to an amendment on alcohol, and I declare that I chair the Commission on Alcohol Harm. This amendment is designed to get the Government to produce a report on labelling, which is long overdue. Some people in this Chamber have been asking for it for 20 years or so, and nobody can quite understand the delay.
My amendment looks at the feasibility of putting information on labels about the harms and calorie content, and it runs completely in line with the Government’s strategy on trying to do something about obesity across the nation. I know that some people in the alcohol industry have suggested that they would like to put a QR code on, but it seems almost impossible to imagine people going with their mobile phones along a supermarket shelf looking at all these QR codes. If they can put some printing on the QR code, they could put on some printing with proper health information, harms information and calorie information in a way that one can read it in a reasonably sized font.
Alcohol is the leading cause of death and ill-health among 15 to 49 year-olds. It is linked to more than 200 health conditions. Alcohol is highly calorific: two glasses of wine can contain almost the entire daily recommended sugar limit. If you have two glasses of some wines, you will have a calorific intake that is the same as that of a big burger. This is not small numbers of calories.
Currently, the only legal requirements on alcohol labels are alcohol by volume, the volume itself and the common allergens that may be present. This does not match up with other food and drink. Alcohol labels do not list ingredients, calories or other information such as health impacts. There is more information on a bottle of orange juice or a carton of milk than there is on a bottle of wine.
The Government have committed money for the drugs strategy. That is most welcome, but I hope it will not all get diverted into drugs of addiction and that it will actually be used to support alcohol treatment services. We know that, in the last few years, only about one in five dependent drinkers have been able to access treatment services for their alcohol addiction.
The problem for consumers when they start out is that they do not know what they are consuming. They do not realise how calorie-laden the drinks are, and they cannot make informed choices about their health. Nor can they make informed choices about the dangers they pose to others, which includes other people with whom they interact when they are intoxicated as well as the dangers in driving.
Voluntary labelling has failed. We have seen again and again that consumers will not get the information they need on alcohol labels unless it is required in legislation. Seven in 10 people think that the warning should be displayed on alcohol labels as a legal requirement. Even the symbol not to drink in pregnancy is so tiny that it is not getting the message across, and foetal alcohol syndrome featured on the “Today” programme just this morning.
I remind the House that we took forward the Domestic Abuse Act, and one in five people are harmed by other people’s drinking.
As for driving, the road death figures show that problem drinkers are responsible for many of the 2,000 seriously injured or killed each year in alcohol-related crashes. The long-awaited consultation on labelling must also look at lowering the blood alcohol limit to 50 milligrams per 100 millilitres of blood, with its potential to reduce fatal alcohol-related crashes by 11%. There is good evidence that those with blood levels between 50 and 80 milligrams per 100 millilitres are six times more likely to be involved in a fatal accident than people who are alcohol free.
The Government’s intention to consult on including more information on alcohol labels is welcome if it is realised, but we have been waiting almost two years for the announced consultation to be launched. During this time, alcohol harm has increased, and deaths from alcohol reached record highs in 2020. Can the Minister tell us when the consultation’s report will be formulated and when it will appear? We cannot leave this unattended to, with consumers not knowing what they are taking whenever they take a drink. I beg to move.

Lord Shipley: My Lords, in moving this amendment, the noble Baroness, Lady Finlay of Llandaff, has emphasised its importance to improving personal and public health. The amendment requires the Secretary of State to publish a report on alcohol labelling, with the aim of improving consumer knowledge about the contents and potential harms of alcohol products. Surely it is in the interests of consumers for labelling on alcoholic products to meet the standards we have come to expect from food labelling.
The context really matters. As the noble Baroness, Lady Finlay, said, alcohol is the leading risk factor contributing to ill health and death for 15 to 49 year- olds, and it is the fifth leading factor across all age groups. Drinking a bottle of wine is, for example, the equivalent of smoking 10 cigarettes, yet a packet of cigarettes must carry a health warning. Surely consumers should be entitled to know how many units of alcohol, how many calories and how much sugar is in a bottle or can. It is very clear that the alcohol industry’s self-regulation has failed, as the noble Baroness, Lady Finlay, said. Commitments were made a decade ago that labelling would improve in line with Department of Health recommendations, yet that has not happened.
I have concluded that the time has come to regulate properly. Food is labelled, showing calories, fat, carbohydrates, sugar, fibre, protein and salt. Much less is shown on alcohol. Wine can show little more than sulphites. Beer can show little more than calories and strength. However, the consequences of high alcohol consumption are there for us all to see. It surely is time for the Government to act. I signed this amendment because it is a very straightforward proposal which all parts of the House should be supporting. I hope very much that the Minister will accept it this afternoon.

Lord Brooke of Alverthorpe: My Lords, I support what has already been said and the amendment in the name of the noble Baroness, Lady Finlay. I also declare an interest in that I was a member of the commission she so ably chaired.
I have been on this, along with others, for a decade. Back in 2011 we had The Government’s Alcohol Strategy, which was very good but regrettably fell by the wayside. I was heartened back in 2019 when the Government, while they are prepared to give details about sugar and calorific effects on almost anything we eat or drink apart from alcohol, were given cause to think about consulting on extending it to alcohol too.
We had a short debate last autumn with the noble Lord, Lord Bethell, who was then the Minister responsible, on calorie and labelling regulations. I was persuaded not to divide the House on the basis of promises given of change coming. The Minister said:
“I give the noble Lord, Lord Brooke, the noble Baroness, Lady Finlay, and all those who have expressed concern about the issue this commitment: the Government will be consulting shortly on whether calorie information should be mandated on prepacked alcohol and alcohol served in pubs and restaurants. Covid-19 makes it more important than ever to support the nation to achieve a healthier weight, and the Government are taking action to help people to lead healthier lives.”—[Official Report, 22/7/21; col. 456.]
It is now 2022 and we still have not got the consultation, so the noble Baroness, Lady Finlay, has posed a fairly simple question.
I think in their heart of hearts the Government know they have to do something on this; it is quite ludicrous that alcohol is out of step with almost all other drinks and food. It is time we brought it into line. Can the Minister please tell us when we are going move on this issue? When are we going to have some definite dates and when will the consultation be concluded?

Lord Bethell: My Lords, I too support the amendment in the name of the noble Baroness, Lady Finlay. I declare my interest as my wife is a director of Diageo. There is no doubt that mandatory calorie labelling of alcohol is one of the most basic steps we need to take to make this country healthier. We have a moral obligation to give people the information they need to make an informed choice. We must take reasonable steps to prevent illness so that we can keep our spiralling health costs down. We must address the health inequalities the Minister has spoken about so thoughtfully on previous occasions. We should do all we can to nudge drinks companies to bring down the calorie levels of some drinks.
As the noble Lord, Lord Brooke, said, these measures have been promised for years. They were made in Tackling obesity: empowering adults and children to live healthier lives, published in July 2020. In October 2020, the then Minister responded to a Written Question, saying:
“we are committed to consult before the end of the year on our intention to make companies provide calorie labelling on all pre-packaged alcohol they sell. The consultation will also cover introducing calorie labelling on alcoholic drinks sold in the out of home sector, for example bought on draught or by the glass.”
The then Minister wrote on June 21 2021:
“We are committed to consult shortly on our intention to make companies provide calorie labelling on all pre-packaged alcohol they sell. The consultation will include further details about the proposed timescale for implementation of the policy.”
In the debate on calorie labelling regulation on 22 July 2021, when alcohol labelling was left off at the last  minute by the then Minster, he said—well, the noble Lord, Lord Brooke, said what the Minister said and I will not repeat it, but it was pretty emphatic.
As the Minister who said and wrote all those words, I ask the current Minister to make the very specific time commitment the amendment seeks.

Lord Vinson: My Lords, there is a sheer impracticality to this suggestion. Whatever the need to get people to drink less, there is the actual practicality of getting millions of bottles of wine shipped from all over the world pre-packaged with this label stuck on them, quite apart from the number of drinks, as has been mentioned, served in carafes or over the counter freely. This is not the way to tackle the problem. It goes to the heart of people’s freedom of choice. They may be overdoing it, but labelling like this is expensive, impractical and it does not work.

Baroness Bennett of Manor Castle: My Lords, I feel I have to respond immediately to that. I intended to speak anyway, having attached my name to an amendment on alcohol advertising in Committee. I would have attached my name to this amendment both in Committee and on Report, had there been space.
The noble Lord, Lord Vinson, talked about freedom of choice. I do not know how many people know that a bottle of wine can contain anywhere between zero and 59 grams of free sugar per bottle. Surely the public do not have the freedom of choice to decide which wine they consume and which level of sugar they consume.
The noble Lord made a point about the difficulty of labelling. Bottles of wine are shipped to many different countries with labels in different languages. We have computers these days which can cope with these things quite simply and easily. It is clearly not beyond the wit of producers to achieve this.
The Government often like to talk about being world-leading. I point them to an editorial in the Lancet Gastroenterology & Hepatology titled Shining a light on international alcohol industry lobbying, showing just how powerful this incredibly wealthy industry is in influencing and damaging public health messages around the world. Would the Government not like to be world- leading in standing up against this industry lobbying, in the interests of public health?

Baroness Walmsley: My Lords, at the risk of being boring, I am one of those people who has been asking for this for the last 20 years. I started off asking for the number of units of alcohol in a bottle of wine. Every manufacturer of these alcoholic drinks knows exactly what goes into them. On the issue of labelling products from abroad, there are a lot of foodstuffs that come from abroad and they have to abide by British rules on labelling, so why not wine and spirits? It is time we did this. It is terribly important for public health, and I hope the Minister will say yes.

Baroness Merron: My Lords, I thank the noble Baroness, Lady Finlay, for bringing forward Amendment 163, and thank other noble Lords for outlining their support for or concerns about it. The amendment refers to publishing a report on alcohol labelling to improve consumer knowledge.
Government data comparing pre-pandemic and post-pandemic figures has shown that sales of alcohol increased by some 25%. This is, as we know, a booming market and consumers need to be equipped with the right information to make informed choices. They have a right to know what is in their drinks and decide what and how much to drink. The consultation promised by the Government, with this in mind, remains something of a consultation in long-overdue waiting.
Currently there is no requirement for alcoholic drinks to include health warnings, drinking guidelines, calorie information or even ingredients. As my noble friend Lord Brooke said, this is very much out of step with any other information on what we consume. There is, as always, a balance to be struck between health improvement measures, consumer information and industry regulation, but this amendment supports a necessary move in the right direction and I hope the Minister will agree to it.

Lord Winston: My Lords, as a doctor and a wine drinker, I have serious concerns about this amendment, particularly, for example, when it comes to the use of fine wine—I think there is broad understanding in the House of what that is—where, in every case, those bottles are labelled with the amount of alcohol. One has to accept that labelling bottles in this way does not change behaviour. We have had committees looking at behaviour change, and the only time we managed to induce behaviour change was with smoking—certainly never with labelling. That is the only time it happened and there were all sorts of reasons for that.
Much of the evidence for alcohol being harmful in minor doses is still dubious and, more importantly, there is real concern that a lot of the so-called evidence is not being put to the real test of whether it makes a difference to behaviour. I must say to the House that I think the noble Lord—I am afraid I do not know his name; my eyes are bad enough not to have been able to see his name on the screen—is right that this is unworkable. It would probably do all sorts of untold damage to what is, for me and no doubt many others, a very fine drink. We need to look seriously at whether we can simply label all bottles.
I just remind the House that there is one amendment that I could have put down. In in vitro fertilisation, embryos are cultured in culture media, which are in fact commercially made and a commercial secret—nobody knows exactly what the composition of those media is. My laboratory is looking at this at the moment. It is really interesting, because some of the products in those culture media may indeed be quite dangerous in terms of epigenetic effects. To me, that seems far more important to regulate than what we are trying to do here with bottles of wine, which is probably not really workable.

Earl Howe: My Lords, this is an important topic, so let me start with an immediate reassurance to the House, which I hope will enable to the noble Baroness to consider withdrawing the amendment. The amendment calls on the Government to publish a report on alcohol labelling. The Government already plan to report on alcohol labelling, as it is a key part of our overall work on reducing alcohol harm. In no sense do we propose to ignore it and I undertake today  that we will report on it. Part of what is taking the time is formulating what the proposals should look like, but I will come on to that.
As part of the Government’s tackling obesity strategy, published in July 2020, we are committed to consulting on whether mandatory calorie labelling should be introduced on all pre-packed alcohol as well as alcoholic drinks sold in the out-of-home sector. In addition, as part of our public consultation, respondents to the consultation will be able to provide suggestions and evidence for additional labelling requirements that they would like the Government to consider, including warning labels and nutritional information. In that sense, the consultation will be even more of a two-way process than perhaps noble Lords might have been expecting. Naturally enough, we make no assumptions in advance about any such proposals; they will have to be looked at on their merits. The consultation will be launched in due course and I can assure noble Lords that the Government will feed back the results to this House. Although, for reasons beyond my control, I have not been able to provide definitive news on the timing of the consultation—much as I would like to—I hope nevertheless that the firm commitment that I have given on the Government’s intention to carry out the consultation and on its scope will have provided the noble Baroness with sufficient reassurance to enable her to question whether she wishes to press her amendment.

Baroness Finlay of Llandaff: My Lords, I am very grateful to everyone who has spoken and I note the tone with which “in due course” was uttered, which is really disappointing. Some very important points have been made, particularly about people really having the choice to know what they are taking into their bodies in the name of alcoholic drinks. May I assure the noble Lord, Lord Winston, that I really do not believe that fine wines will be sacrificed on the altar of public health? Very few people drink fine wines; most people drink drinks bottled and labelled in this country—the obesogenic effect is really important.
However, I am a realist and I am aware that the chance of this being thrown out when it goes to the other place means that it would not remain in the Bill. I hope the Government will take the message back to the Secretary of State to empower him to grasp the nettle, provide leadership in public health and, for the first time, proceed to make sure that people know what they are drinking and what the harms are—they might prefer to go out with their family and eat a large burger than have two glasses of wine. Given that, and the reality of the situation we are in, we will hold the Government’s feet to the fire over what “in due course” means; I hope it is a very short course. On that, I beg leave to withdraw the amendment.
Amendment 163 withdrawn.

Amendment 164

Lord Hunt of Kings Heath: Moved by Lord Hunt of Kings Heath
164: After Clause 164, insert the following new Clause—“Vaccine damage payments  Within 6 months of the passing of this Act, the Secretary of State must establish an independent judge led review into the operation of the Vaccine Damage Payments Act 1979 and the adequacy of payments offered to persons seriously injured, or bereaved, consequent upon vaccination against any of the specified diseases to which the Act applies.”Member’s explanatory statementThe Vaccine Damage Payment Act is now more than 40 years old and the aim of the amendment is to ensure that a judge led review takes place into the operation of the Act.

Lord Hunt of Kings Heath: My Lords, I am speaking to my Amendment 164 but I also strongly associate myself with Amendment 180 in the name of the noble Baroness, Lady Cumberlege.
In Committee, I raised concerns about a small number of individuals and families who have paid the highest personal price for the success of the Covid vaccination programme, suffering bereavement or serious injury as a direct consequence of adverse reactions to vaccination. We have the Vaccine Damage Payments Act 1979, which was intended to provide a safety net for such individuals by providing a modest ex-gratia payment to those injured or bereaved in recognition of the fact that their injuries and losses flowed directly from “doing the right thing” by having the vaccine for the benefit of society as a whole.
The scheme is 40 years old and no longer fit for purpose. The maximum payment is capped at £120,000, which is far too little to provide proper financial support for families who have maybe suffered the death of a main income earner. The current scheme also requires that all eligible applicants in the UK must meet what is called the 60% disablement criterion. This criterion is antiquated, counterproductive and unfair: many applicants could have significant injuries and may be disabled up to 59% and yet, on the basis of the current scheme, they would have no access to funds.
The current system takes far too long to provide the payment. The causal connection between certain injuries and Covid vaccination is now accepted, I believe, by clinicians and regulators. However, despite providing death certificates that identify Covid-19 as a cause of death and medical reports confirming Covid-19 as the cause of injury, the scheme still estimates that it will take more than six months to begin to process claims submitted under the scheme more than 12 months ago.
In Committee—I thank Ministers for another meeting yesterday to discuss this further—the noble Earl explained that responsibility for the operation of the scheme has transferred from the DWP to his department and the NHS Business Services Authority has taken over the operation of the scheme. This is very welcome and I am glad that it has happened. However, this is not an issue that will disappear any time soon—Covid is not an issue that is disappearing. Further vaccinations will come along and there will unfortunately be adverse effects for a very small group of people, in the interest of the greater good.
I believe that the scheme offers too little, too late, to too few and I have three asks of Ministers. First, I ask that Ministers and the NHS Business Services Authority engage with the families affected. It would be valuable if Ministers and senior executives at the NHS Business Services Authority were to meet some of the families.  I know that Sarah Moore of Hausfeld will be happy to facilitate this, and I pay tribute to her. Secondly, I ask that everything that can be done is done to speed up the process of meeting claims. Thirdly, on behalf of the families and individuals, I ask the Government to consider undertaking a review of the scheme in the light of current experience and particularly look at the 60% criteria bar and the £120,000 limit which has not been updated for a number of years.
The vaccination programme has been a wonderful success both in this country and globally. It is very unfortunate that inevitably there will be a small group of people damaged in the process. I think we owe it to them to have a generous scheme. I beg to move.

Baroness Cumberlege: My Lords, my amendment is grouped with the amendment in the name of the noble Lord, Lord Hunt, whose persistence I admire concerning those who have suffered vaccine damage. My amendment is slightly different, but it is along the same lines in that it is about unintentional outcomes and redress for those who have suffered.
My amendment requires the Secretary of State to bring forward proposals for redress schemes to help those who have suffered avoidable harm linked to the three medical interventions that were examined in the report from the Independent Medicines and Medical Devices Safety Review, which I chaired. These are hormone pregnancy tests—the most common being Primodos—the epilepsy drug sodium valproate and pelvic mesh, which was used to treat stress urinary incontinence and pelvic organ prolapse.
I will be brief, but I make no apology for bringing this before your Lordships’ House again because the case for these schemes is so compelling. These are people who, through no fault of their own, have suffered terribly and had their lives changed for the worse and in some cases completely ruined—all because of mistakes, errors of judgment, oversights and a refusal to listen across the healthcare system. In each case—Primodos, valproate and mesh—harm could and should have been avoided. If that does not underline the moral and ethical case for providing some help, then I really do not know what does.
I believe that my noble friend the Minister and his colleagues are genuinely sympathetic to the plight of these women and their children, but I sense that they are hesitant. I urge them to overcome some of this reluctance and act now. The suffering is immense, it is continuing even today, and very sadly people are dying before they receive the help they need. I remind my noble friend that these redress schemes are not the same as compensation. We are not talking about large sums of money. We are talking only about modest funds to help with the challenges of daily life: to pay for mobility aids, a respite break, travel to hospital. This is help that they do not and cannot access at the moment from the NHS, social services or elsewhere.
In Scotland, the Government there have acted. A scheme was set up to provide help to women suffering from mesh complications. It is modest: it was given a £1 million budget and women had to apply to it to be eligible. But it was welcomed, and it has helped. That is the kind of help I have in mind. Sums of that scale  are barely noticeable in the context of the hundreds of billions we spend on health and social care, yet these small sums would mean so much to so many.
Are there concerns that this might set a precedent and that before we know it dozens of other groups of people who have suffered will all want the same? I do not believe so. That has not happened in Scotland. Thalidomide did not lead to an avalanche of other groups requiring help. We have existing schemes to help others who have been harmed. If the Government really believe that compensation is the better way for these people to get help, they are mistaken. The fact is that many have tried to obtain compensation through the courts. It is time-consuming, costly, stressful, adversarial and, worst of all, it simply has not worked.
The three groups that Amendment 180 is designed to help are small in number—not millions of people, not hundreds of thousands. I do not believe that an unwelcome precedent would be set. I do not believe that these schemes would cost the earth. The cost would be modest and can be contained and managed. I believe the benefits will outweigh the cost and that we have a moral and ethical duty to help these people. They have suffered for years and in some cases for decades. Surely the measure of a decent society is how well it looks after those who have suffered harm, especially where that harm could and should have been avoided.
I have met hundreds of people who have suffered; even today I get a lot of emails, phone calls and letters. We have heard from many more people. I am clear that help is both needed and deserved. People should not be made to wait any longer. I hope that my noble friend the Minister will agree.

Lord Geddes: My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

Baroness Brinton: My Lords, I speak from these Benches to support both amendments in this group. The noble Lord, Lord Hunt, introduced his Amendment 164 on vaccine damage payments, explaining that the current law as set out in the Vaccine Damage Payments Act 1979 is now over 40 years old. The amendment asks for a judge-led review on what parts of the Act need to be updated, especially the maximum payable as a result of vaccine damage.
The amendment proposes a small and focused review that will assist those who have been damaged by vaccines and will help the NHS, Government and Parliament ensure that the legislation is fit for purpose in the 21st century, especially for the families of those damaged by the Covid vaccine and of the very few who died. They may be an infinitesimally small percentage of those who have been vaccinated but their lives have been turned upside down because of doing the right thing.
Amendment 180 in the name of the noble Baroness, Lady Cumberlege, is an important pillar of delivering the recommendations from her First Do No Harm review, which outlined routes to assist those who had been harmed by an avoidable harm as a result of using certain HPTs, sodium valproate or pelvic mesh.  The victims of this avoidable harm are not to blame for it either, but are living out the consequences, including needing additional care for the rest of their lives. I know that the Government have been very supportive of the First Do No Harm review. I hope that they can be persuaded that now is the time to introduce schemes that will help these people. While I fear that there may not be movement on these two amendments today, I hope that the Minister can outline when there is likely to be progress on these two financially modest but essential areas that could right some long-term wrongs.

Baroness Wheeler: My Lords, my noble friend has returned with his amendment on the need for an expert-led review on the 40 year-old Vaccine Damage Payments Act, and I am pleased that the meeting he sought with the Ministers has taken place. The amendment is a timely reminder for all of us that while the vaccination programme against Covid has been hugely successful, for a small group of people suffering very serious adverse effects and deteriorating health as a result of having the vaccination, the experience has been devastating, as the noble Baroness, Lady Brinton, underlined. The current legislation dealing with compensation arrangements is not fit for purpose: in the words of my noble friend, it offers too little, too late and to too few people. I hope the Minister acknowledges the need to meet and engage with the families of those affected, and that he looks urgently at the ways in which claims under the current system can be speeded up, and he also accepts the need for the review of the scheme and the next steps that have to be taken on this.
My noble friend has also added his name to Amendment 180 from the noble Baroness, Lady Cumberlege, on her unrelenting campaign for separate compensation schemes to meet the cost of care and support for the victims highlighted in her First Do No Harm report. Once again, we have heard convincing and forceful contributions from the noble Baronesses, Lady Cumberlege and Lady Brinton, which we on these Benches strongly support, calling for an independent redress agency for the three patient groups covered by the First Do No Harm report. The Government’s positive response to another key aspect of the First Do No Harm report, to improve patient safety for the future, including establishing the patient safety commissioner, is a welcome and necessary development. But the redress agency needs to be there to provide care and support for the thousands of women who suffered, and whose needs will not be met by the healthcare system, social care support or social security benefits support.
I hope the Minister has considered the matter carefully since Committee, and will report positively to the House on the ongoing discussions and progress which will ensure the strongest recompense possible for the people we are concerned about.

Earl Howe: My Lords, I will turn first, if I may, to the amendment in the name of the noble Lord, Lord Hunt of Kings Heath, on the Vaccine Damage  Payment Scheme, and start by thanking him for his campaigning on this issue, and for the informative debates we have had today and in Committee.
As we discussed in Committee, since the NHS Business Services Authority took over responsibility for the Vaccine Damage Payment Scheme from the Department for Work and Pensions in November 2021, we have started to find ways to improve the operation of the scheme. The most important thing the NHS Business Services Authority is looking do to is to improve the claimant journey on the scheme, and that means making engagements with claimants more personalised, as well as giving claimants access to more general support. The crucial part of this drive is to reduce response times, which the authority knows has been a cause of dissatisfaction, particularly during Covid; in other words, the whole process is being modernised.
The NHS Business Services Authority has done its best to hit the ground running. Since taking over in November, it has already contacted all applicants to update them on their cases and it has also allocated additional resource to the operation of the scheme. I can assure the noble Lord that the department will further engage with the NHS Business Services Authority to ensure that these service improvements, greater digitisation in particular, really do make headway. There is already regular dialogue on this.
With all this enhanced activity happening, I do not think this is right time to establish an independent review into the VDPS. As the noble Lord will know, reviews take significant time and they carry substantial costs to the organisation, not just financial but in terms of leadership focus and energy. Instead, we think it is a better use of resources to focus on making the changes that we know need to happen; that is, to improve the claimant’s journey, and to modernise the process for claimants, as well as scaling up the capacity of the VDPS. We will keep the progress on these under regular scrutiny, and I am sure we will report regularly to this House as we do so.
I will address the noble Lord’s three key questions. First, I should be happy to facilitate a meeting with representatives of the families, and my honourable friend Maria Caulfield, who is the Minister with direct responsibility for the scheme, will be pleased to see them. Secondly, as I have already indicated, reducing response times is one of the NHS Business Services Authority’s key objectives. Thirdly, the noble Lord asked whether the Government would undertake a review of the scheme. I simply remind the noble Lord that the scheme has been revised many times since its inception, which shows that it is reviewed regularly as a matter of course, but perhaps it is worth my making the point that the VDPS is not a compensation scheme; nor is it designed to cover all expenses associated with severe disablement, which are catered for from the public purse in other ways. I hope that is helpful to the noble Lord, and that on the basis of those assurances he will feel able to withdraw his amendment.
Before I address the detail of Amendment 180, I would like to again put on record my thanks to my noble friend Lady Cumberlege for her continued commitment to the issues she has so powerfully spoken about, and the diligence and dedication of the IMMDS  team, and the brave testimonies of those who contributed to the IMMDS review. As my noble friend knows, the Government have accepted the majority of the report’s nine strategic recommendations and 50 actions for improvement, and are taking forward work to improve patient safety. This includes establishing specialist mesh removal centres, the ninth of which opens in Bristol this month, and work to improve the care pathways for children and families affected by medicines during pregnancy.
We remain committed to delivering improvements in patient safety across the board. We are focusing government funds on initiatives that directly improve future safety. For this reason, the Government have already published their decision that redress schemes will not be established for people affected by hormone pregnancy tests, sodium valproate or pelvic mesh. I realise that was a disappointing decision for my noble friend, and I am always very sorry to disappoint her, but, for the reasons I have given, I ask her not to move Amendment 180 when it is reached.

Lord Hunt of Kings Heath: My Lords, I am very grateful to the noble Earl, Lord Howe, the noble Baroness, Lady Brinton, and my noble friend Lady Wheeler for their support. I empathise with the comments of the noble Baroness, Lady Cumberlege, and her report, which was far-reaching. Having met some of the women who were affected, I know how keenly the noble Baroness, Lady Cumberlege, feels about these issues. It is disappointing that the Government have rejected this particular request, although they have accepted many of her recommendations. It leaves the groups of women whom we have met to continue with their long, hard campaign, but they will continue, and one day a Government will agree to give them some of the support that they deserve.
On my own amendment, I pay tribute to the work of the NHS Business Services Authority. I am very glad that it took over responsibility for the scheme, and I wish it well in speeding up the process of claims. I am grateful to the noble Earl for facilitating a meeting between representatives of the families and the Minister—that is very welcome indeed. All I would say is that as the Business Services Authority continues its work, it is bound to come across issues in relation to the operation of the scheme, and I hope the Government will reflect on that and look at further improvements to the scheme. Having said that, I beg leave to withdraw my amendment.
Amendment 164 withdrawn.

Amendment 165

Lord Hunt of Kings Heath: Moved by Lord Hunt of Kings Heath
165: After Clause 164, insert the following new Clause—“Secretary of State: Duty to promote and ensure the full integration of self care for minor ailments within the health system (1) The Secretary of State, in exercise of his or her functions, must promote self care for minor ailments and prepare a national self care strategy to integrate self care fully into the wider health system.(2) The national self care strategy referred to in subsection (1) must include measures to—(a) improve inequalities in health literacy,  (b) enhance the understanding of primary and secondary age children on how to self care,(c) introduce self care modules in healthcare professionals’ training curricula and continuing professional development,(d) make best use of, and expand, the Community Pharmacist Consultation Service,(e) improve access to effective self care treatments,(f) enable community pharmacists to refer people directly to other healthcare professionals,(g) ensure better support for Primary Care Networks (PCNs) to deliver self care,(h) evaluate the use of technologies developed during the COVID-19 pandemic to promote greater self care, and(i) accelerate efforts to enable community pharmacists to populate medical records.”Member’s explanatory statementThis amendment would ensure that the Secretary of State promotes self care for minor ailments and publishes a national self care strategy to fully integrate it into the wider health system.

Lord Hunt of Kings Heath: My Lords, Amendment 165 requires the Secretary of State to
“promote self care for minor ailments and prepare a national self care strategy”.
I hope that Ministers will just agree to this, without very much debate.
Self-care is defined as
“the actions individuals take for themselves, on behalf of and with others, to develop, protect, maintain and improve their health.”
It is an important but often overlooked part of the primary care pathway.
Given all the pressures that there are on the health service and that there are going to be over the next 30 to 40 years, surely we should do everything we can to encourage self-help for minor ailments. During Covid, the importance of self-care in reducing the burden on GPs and A&E became very self-evident. Since the outbreak started, people with minor ailments were not able to visit their GP in the traditional manner and learned, or at least practised, self-help behaviours instead. A survey carried out by PAGB, the consumer healthcare association, during the first national lockdown indicated that the pandemic has had an impact on people’s attitudes to self-care. Some 69% of people who would not have considered practising self-care prior to the pandemic said that they were more likely to do so after their experience of lockdown.
Interestingly, if the Government were prepared to run with this strategy, there are all sorts of behaviours that they could start to encourage. They could ensure that individuals understand or are willing to practise self-care; ensure a cultural shift among healthcare professionals toward well-being, enabling people to self-care; ensure that the system is supported to encourage self-care where appropriate, with pharmacies, of course, playing a big role in that; encourage the use of digital technology; enhance the national curriculum on self-care for schoolchildren; and introduce self-care modules in healthcare professionals’ training curriculum.
I come back to the point that the Minister and noble Lords know that the health service is currently under huge pressure, not just because of the backlog. Already before the pandemic, the health service was  really struggling to meet its targets. The demographics, the growing older population and all these factors suggest that the NHS will struggle hugely to cope with the pressure on it over the next 20, 30 and 40 years. Surely some part of the strategy to deal with this is to encourage all of us not just to look after our own health more but, where we can, to self-help. I would have thought that message would have been accepted with alacrity on the Government Front Bench. I hope the Minister will be able to say that this is very much taken to heart and that the Government really will start to drive the new strategy. I beg to move.

Lord Clement-Jones: My Lords, I rise briefly to support Amendment 165, in the name of the noble Lord, Lord Hunt, and thank him for putting it forward. Self-care has an important role to play in supporting people to manage their own health needs, and also in alleviating an unsustainable demand on GP and A&E services. As the noble Lord described, prior to the coronavirus pandemic there were some 18 million GP appointments and 3.7 million visits to A&E every year for conditions which people could have looked after themselves or sought advice from a pharmacist. It is estimated that this was costing the NHS in the region of £1.5 billion a year.
During the coronavirus, again as the noble Lord described, surveys have shown a much greater willingness among members of the public to self-care for these self-treatable conditions. But it is vital that appropriate policies are put in place to ensure that, as we emerge from the pandemic, people who can self-care continue to do so. It is evident now that self-care can help address many of the challenges we face in the NHS today, but to do so we need to address some of the system barriers to self-care, as described in this amendment, and unlock the important behavioural shifts that enabled people to self-care during the pandemic.
In particular, I will highlight how the NHS can make much better use of digital technologies and community pharmacists to enable people to self-care. We need to make better use of the technologies that the NHS has embraced over the course of the pandemic, such as the Covid-19 symptom checker on the NHS website. The digital triaging technology should be used to support the expansion of the community pharmacist consultation service to enable people to follow an algorithm online to get a referral for a consultation with a local pharmacist. It is critical, if we are to optimise the role of pharmacists—I am a big supporter of community pharmacists—that we give them the digital tools and information they need to support people. At present, a pharmacist cannot routinely record the advice or medication they give people, despite receiving training. The NHS must address the question of interoperability in IT systems, so that pharmacists can have access to read and to input into people’s medical records and enable pharmacists to be a core part of an individual’s primary healthcare team.
The pandemic has highlighted how quickly the NHS and patients can adopt technological and digital changes. Realising the Potential: Developing a Blueprint  for a Self Care Strategy for England, a document launched last October, is an excellent blueprint for this. A whole range of organisations, including NHS clinical commissioners, the RCN, pharmacy organisations, the Self Care Forum and, of course, the PAGB, have worked together to develop this blueprint for a comprehensive national self-care strategy to support the introduction of self-care policies throughout the NHS in England. It contains policy proposals and case studies, in particular in relation to digital technologies, which set out how the NHS can fully embed self-care and pharmacy into primary care.
I hope the Minister today will outline how the Government are ensuring that the NHS can adopt these proposals, which learn from the pandemic, and will expand them to support individuals to enable self-care.

Baroness Wheeler: My Lords, we had a good debate in Committee on the issue of self-care and the management of health conditions, particularly on its importance as a key part of the primary care pathway. This was underlined in diabetes care and, as I also emphasised, in the care and treatment of people with rare diseases, most of whom are living with lifelong conditions. As vice-chair of the Specialised Healthcare Alliance of charities supporting this key group of patients, I know that they often do not feel sufficiently supported in terms of care and support and health and system information, and with physical and daily living.
As the two noble Lords have stressed, the Health Foundation’s research on the effective self-management by patients has shown a significant reduction in the need for emergency admissions to hospital and in A&E attendances, and fewer GP appointments. In this context, Amendment 165 makes a great deal of sense. If patients with, for example, rare diseases receive appropriate support to manage their less intensive care needs, then promoting self-care has the potential to help them prevent their conditions from deteriorating, to improve their lives and to reduce demands on the NHS, as the noble Lords have stressed.
We therefore strongly support the need for the development of a national self-care strategy, starting with awareness raising among primary and secondary children on how to self-care, and with appropriate staff and management training of healthcare professionals. Improved technologies, as underlined by the noble Lord, Lord Clement-Jones, especially those developed during the pandemic, will have a key role in broadening access to effective self-care and ensuring the better support from primary and community pharmacists that we all want to see. I hope the Minister will respond positively to this amendment.

Baroness Penn: My Lords, I thank the noble Lord, Lord Hunt, for bringing forward a debate on this issue. I reassure him and other noble Lords that the Government absolutely agree that supporting people to maintain their health and well-being and to manage self-treatable conditions is a vital part of delivering a comprehensive health service. Indeed, much of what the amendment seeks to achieve is already government policy. However, I do not agree that requiring the Secretary of State to prepare a single national strategy  would add value. Instead, we are threading self-care through a wide range of work, reflecting the range of areas that it impacts upon.
A good deal of work is already under way. The community pharmacy contractual framework for 2019 to 2024 five-year deal sets out how community pharmacy will support the NHS long-term plan. Community pharmacies, which provide easy access to the NHS, are already required to support patient self-care, signpost to other parts of the NHS and local services as necessary, and help people to live healthily.
I am especially aware of the interest the Proprietary Association of Great Britain has shown in this area. The Department of Health and Social Care officials have met with it to discuss its blueprint for a self-care strategy in England and will continue to engage with it about further supporting self-care throughout our healthcare system.
We do not think placing an additional duty on the Secretary of State would be the right way to support this work, as it would take it out of the NHS long-term plan, where it belongs as part of a holistic approach to the provision of a health service. It could risk making it more disjointed rather than integrated in its approach, but noble Lords made a really important point about demand on our health service and the role that self-care has in this. Prevention was a key theme of a speech by my right honourable friend the Secretary of State last week and, clearly, elements of self-care and prevention go hand in hand with each other, particularly in the use of new technology.
Noble Lords also made an important point about how we can use self-care, particularly at community pharmacies, to reduce pressure on GPs and A&E departments. All community pharmacies are required, as I said, to provide support for self-care. To ensure that people get directed to the right support for their health needs, we have introduced referral systems from NHS 111 and GPs to pharmacies for advice and treatment for minor illnesses. We are also exploring expanding referrals from other settings, including urgent treatment centres and A&E to community pharmacies.
I hope that gives noble Lords some reassurance that we place an importance on self-care, as part of our health service. That will only increase in future and work is under way in multiple areas of the health service to do that. I hope, therefore, that the noble Lord is able to withdraw his amendment.

Lord Hunt of Kings Heath: I am grateful to the noble Lord, Lord Clement-Jones, and my noble friend Lady Wheeler for their support, and to the Minister. I am glad to hear her recognition of the importance of community pharmacy, and about the meetings between officials and the PAGB. That is very welcome.
I agree that the interrelationship between self-care and prevention is important—as is, may I say, personal responsibility. I also agree that the pressure we face in the system is such that this is important for the future. The Government may not want a strategy but, at some point, setting out their aim in this area and giving the right signals to us as individuals, but also to the system, would be very helpful. I beg leave to withdraw my amendment.
Amendment 165 withdrawn.

Amendment 166

Lord Moylan: Moved by Lord Moylan
166: After Clause 164, insert the following new Clause—“Guidance on Pancreatic Enzyme Replacement Therapy(1) The Secretary of State must, within six months of this Act being passed, publish national guidance making the appropriate prescription of Pancreatic Enzyme Replacement Therapy a priority within pancreatic cancer care in the NHS through the implementation of national targets.(2) The Secretary of State must, within a year of this Act being passed and every year thereafter, publish data on the prescription of Pancreatic Enzyme Replacement Therapy for pancreatic cancer patients.”

Lord Moylan: My Lords, pancreatic cancer is a terrible disease, as noble Lords know: 10,500 people in the UK a year are diagnosed with it, 9,000 people a year die from it and five-year survival rates in the UK rank us 29th out of 33 countries with comparable data. The Government recognise that this is not good enough, so they are commissioning an audit of existing services as a first step to improvement. That is wholly welcome but it is turning out to be a very slow business, with the first data expected in 2023 and no timetable for action to follow.
Amendment 167 in my name is intended to add a sense of urgency to that. I am grateful for the support it has received from the noble Lords, Lord Aberdare and Lord Patel, and the noble Baroness, Lady Hayman of Ullock. However, I turn my attention this evening principally to Amendment 166 in my name, which is also supported by the noble Baroness, Lady Finlay of Llandaff. It relates to improving the treatment of those diagnosed with pancreatic cancer and can be delivered immediately.
The end-of-life experience of pancreatic cancer sufferers includes huge difficulties in eating and digesting food, because of the lack of an enzyme normally produced by a healthy pancreas. Pancreatic enzyme replacement therapy, or PERT, is a simple tablet costing only £7 a day. It is fully approved by NICE and allows sufferers to eat, but it reaches only about 50% of pancreatic cancer sufferers. Why is that? The truth is that we do not know exactly and, pending the audit, may not be able to say exactly. But a likely reason is that diagnosis of pancreatic cancer occurs so late because the symptoms present so late that a prompt decision has to be made about those who might be saved by surgery and those for whom nothing can be done. The former go to specialists, who tend to be aware of PERT and prescribe it. The latter, on the whole, move into more general palliative settings, where it seems that knowledge and understanding of PERT is less widespread.
Amendment 166 obliges the Government to make increasing prescription rates for PERT a national priority, without waiting for the outcome of the current audit. It was tabled in Committee and got a somewhat dusty answer from the Government Front Bench, hence its return today. To say that emphasising PERT should await the outcome of the audit would be to condemn literally tens of thousands of people to unnecessary suffering at end of life so I think these amendments,  especially Amendment 166, will find general support across the House. Happily, I understand that my noble friend the Minister will be able to offer certain assurances when he speaks that would make any such Division unnecessary.
Before I conclude, there is one extra step that the Government could make early progress on that would be welcome. It is in disaggregating the data about the prescription of PERT, which can be prescribed for conditions other than pancreatic cancer. While the Government and the National Health Service are able to point to figures showing slowly increasing PERT prescription rates, what they cannot do at the moment is to say whether it is being prescribed for pancreatic cancer or some other condition. Disaggregating that data will be an important job for the Government to do, even to make progress with their own audit. Some comments on that today would also be welcome so, for the moment, I beg to move.

Lord Aberdare: My Lords, I am pleased to speak in support of Amendments 166 and 167 in the name of the noble Lord, Lord Moylan, addressing pancreatic cancer, to which I have added my name. I shall be brief as he has already made the case for these amendments so strongly. Both amendments include deadlines: for guidance on pancreatic enzyme replacement therapy to be published within six months; for data on PERT prescription to be published within a year, and yearly thereafter; and for a report on the audit of pancreatic cancer services to be laid before Parliament within six months and updated six-monthly. The reason for these deadlines comes down to a single word: urgency.
On average, pancreatic cancer sufferers live for only six months following diagnosis and more than half of the 10,000 a year will die within three months. That is hardly enough time for them to say proper goodbyes to their family and close friends, let alone to put their financial and other affairs in order, so the usual government timescales of “in due course” or even “shortly” are nowhere near fast enough for action to improve their treatment. I hope we may hear something more encouraging from the Minister.
Some such improvements may help extend their lives, even if only by a matter of months, but others equally important, such as PERT, may make a significant difference to the quality of the time remaining to them, however short. PERT enables pancreatic sufferers to digest their food; in some cases, it may even help them to gain the strength needed to undergo life-saving surgery. It is recommended by NICE and widely available. It costs just £7 a day per patient. I find it shocking that, as the noble Lord told us, half of patients who need PERT are not being prescribed it, mainly because of lack of awareness among non-specialist staff. Surely the Government can and should investigate and address this with urgency, as required by Amendment 166.
Amendment 167 would impose a broader requirement on government to take action on the findings of the very welcome audit of pancreatic cancer services currently under way. Given the short survival times of pancreatic  cancer patients and the need to ensure that the treatment they receive during that period is as effective as possible at minimising their suffering, it is not good enough to wait for final completion of the audit before taking any action. Progress on the audit should be regularly reported at six-monthly intervals, so that improvements in pancreatic cancer treatment and services can be implemented with the urgency owed to patients.
I strongly support these two amendments and hope the Minister is at least able to commit to urgent action to improve the experience of pancreatic cancer patients, preferably by accepting both the amendments but, if not, in some other way.

Baroness Finlay of Llandaff: My Lords, I was glad to have been able to put my name to Amendment 166 about PERT. In this Bill, the Government have introduced a milestone in changing the care of people who are facing serious illness at the end of life.
The reality, as we have already heard, is that the majority of patients with pancreatic cancer are diagnosed late, because it comes in the head of the pancreas. The pancreas has two parts—the head and the tail. But, because it can grow without causing much pain in the initial stages, it often goes undetected until it is fairly advanced. That means the outlook is poor. The other thing it does, as it grows, is block off the flow of enzymes into the gut. Without replacement, these patients get a malabsorption syndrome; they can get terrible diarrhoea and muscle wasting, because they are not absorbing the nutrients they need.
This amendment is very important. It could quite easily build on the network that will now be in place to commission specialist palliative care services. The move the Government have made has been welcomed across palliative care in this country and is being seen as a way to dramatically change the care of patients. With data information flows now integrated and networked across the NHS, we will be able to get accurate data on how many patients with pancreatic cancer are getting replacement therapy when they need it. Some people do not need it; some need it later on. This is part of building on the important foundation the Government have laid. It was that which persuaded me to put my name to Amendment 166.
Another point I would like to make is about improving things for the lowest quartile of the population. Incidence of pancreatic cancer is highest in the most deprived areas and it is higher in women than in men. Part of levelling up, to help people to live well for as long as they can, is making sure they get the enzyme replacement they need.

Baroness Walmsley: My Lords, I have in my hands the latest cancer waiting time figures. It is very unfortunate that, despite the hard work of NHS staff, every single metric was worse in January than in December. It therefore seems a great pity that not all patients who have a diagnosis of this dreadful disease of pancreatic cancer can get this medicine, which can improve and even extend their lives.
I well remember a senior, well-loved and well-respected Member of the Labour Benches who died of this dreadful disease. We lost him far too early, because  this disease takes people very quickly. Anything at all the Minister can say to encourage us that this effective and approved medicine can be made fully available to everybody who needs it—depending on the conditions, as outlined by the noble Baroness, Lady Finlay—would be helpful.

Baroness Thornton: My Lords, can I say how much I support this suite of amendments? I congratulate the noble Lord, Lord Moylan, for tabling and speaking to them. This most lethal of killers has been defying science—or we at least have not had enough investment in the science—for many years. This means the survival rate is still not as it should be and as it is for other cancers. Anything that pushes the NHS and research community to tackle this and to set the targets that are needed to do so is very welcome. I look forward to what the Minister has to say.

Lord Kamall: I thank noble Lords for bringing forward this further debate on the subject of pancreatic cancer services. I begin by confirming that the pancreatic cancer audit is included in the national cancer audit collaborating centre tender, which is currently live. Reporting timelines are included in the specification for this audit, developed in partnership with NHS England and NHS Improvement. However, I hope noble Lords will understand that, during a live tender, the document is commercially sensitive and cannot be shared beyond the commissioning team, as this would risk jeopardising the procurement process. While I recognise that it may be disappointing that I am unable to confirm the timeline for the pancreatic cancer audit until the procurement process is completed, I can say that the future contract to follow the procurement process in relation to the clinical audits is anticipated to start this autumn.
The normal process for a new national audit is a year of development and set-up, followed by data collection and analysis. The publication of the data would then follow. However, on a more positive note—and I hope my noble friend Lord Moylan considers this response less dusty—I can confirm that, alongside the audit of cancer services, important actions are being taken to ensure that clinicians are able to take informed decisions. NHS England and NHS Improvement have ensured that guidance on pancreatic enzyme replacement therapy is shared with cancer alliances to disseminate to clinical teams in their area. NHS England and NHS Improvement will also continue to work with Pancreatic Cancer UK to raise awareness among the clinical community about the value of PERT for many patients with pancreatic cancer.
Noble Lords will be aware that NICE has a clinical guideline, NG85, recommending that PERT should be offered to patients with inoperable pancreatic cancer, and that NICE has also included PERT in its quality standard on pancreatic cancer. NICE clinical guidelines are developed by experts based on a thorough assessment of the available evidence, but they do not replace the judgment of healthcare professionals. They are not mandatory, but they represent best practice. The NHS is expected to take them fully into account in ensuring that services meet the needs of patients. Ultimately,  the use of PERT in individual cases is for clinical decision- making, following a discussion between doctor and patient. As such, national targets would not be appropriate.
My noble friend asked another question on data. PERT prescription data is already published online through the English prescribing dataset. This shows that levels of prescription have been rising. The data does not currently differentiate between prescription for pancreatic cancer patients and for people with other conditions. However, NHS England and NHS Improvement will consider PERT prescription data during the scoping of the pancreatic cancer audit.
I end by thanking my noble friend Lord Moylan for his constructive engagement and for pushing the Government on this. But I hope that the reassurances I have given are sufficient to persuade him to withdraw his amendment.

Lord Moylan: My Lords, I am very grateful to noble Lords who have spoken, particularly the noble Lord, Lord Aberdare, and the noble Baronesses, Lady Finlay of Llandaff, Lady Walmsley and Lady Thornton. I know that support for the principle behind these amendments is widespread throughout the House. The Minister has also taken that on board, and I am grateful to him not only for his engagement before this short debate but for the words he uttered from the Dispatch Box. He will be in no doubt that noble Lords will be paying attention to these prescribing rates in the future, carefully following what is happening, monitoring and asking questions to ensure that the information is getting to clinicians and that the medicines are getting to the patients who will benefit from them.
Before I sit down, I want to say a word of thanks to the excellent charity Pancreatic Cancer UK, with which I have worked on this and which I know also works with officials at the department to improve treatment for pancreatic cancer patients. I will test my licence a little further by saying that it is not only pancreatic cancer; there are also conditions such as bile duct cancer, which are just as devastating and which we, as a nation and a National Health Service, need to bring to the fore so that people get better treatment, better care and early diagnosis. We really can do this.
With that, I express gratitude to my noble friend the Minister and the other noble Lords who have spoken. I beg leave to withdraw the amendment.
Amendment 166 withdrawn.
Amendments 167 to 169 not moved.

Baroness Henig: My Lords, I inform the House that the noble Baronesses, Lady Masham of Ilton and Lady Brinton, and the noble Lord, Lord Howarth of Newport, will take part in the following debate remotely.

Amendment 170

Lord Forsyth of Drumlean: Moved by Lord Forsyth of Drumlean
170: After Clause 164, insert the following new Clause—“Assisted dying(1) The Secretary of State must, within the period of 12 months beginning with the day on which this Act is passed, lay before Parliament a draft Bill to permit  terminally ill, mentally competent adults legally to end their own lives with medical assistance.(2) In preparing the draft Bill and any accompanying documents and in making arrangements to lay them before Parliament, the Secretary of State must take account of the need—(a) to respect that this is a matter of conscience, and(b) to enable Parliament to consider the issue.”

Lord Forsyth of Drumlean: My Lords, we are on Report and I know that a number of colleagues have engagements and want to see this matter resolved as speedily as possible, so I will be brief and stick to the substance of my amendment.
This amendment has nothing whatever to do with the rights and wrongs of assisted dying, and I apologise to colleagues who have received many letters and emails urging them to vote against it from people who have been told that it does. The amendment would simply enable a Private Member’s Bill on assisted dying to be properly considered by Parliament at a time when the courts and the vast majority of the public are crying out for this to be done.
Time and again, private Members’ legislation on assisted dying is destroyed in Committee after enjoying strong support at Second Reading. The Bill from the noble and learned Lord, Lord Falconer, and, most recently, the Bill from the noble Baroness, Lady Meacher, suffered this fate. The noble Baroness’s Bill was subject to more than 200 amendments, many of them tabled by Members who expressed complete opposition in principle to it at its Second Reading. It is hard to escape the conclusion that their purpose was to ensure that the Bill ran out of time. They succeeded; it is dead. A particularly egregious example was an amendment requiring a terminally ill person to give 12 months’ notice of a diagnosis of having only six months to live. You do not need to take my word for it that some people are using these tactics, which are deliberately intended to subvert the democratic process and prevent Parliament coming to a considered view.
This is what Care Not Killing, as it calls itself, had to say in an email sent to its supporters on 24 January 2022 at 6.29 pm about new subsection (2), proposed by my amendment, which would require the Secretary of State to treat this issue as “a matter of conscience” and enable Parliament to consider it:
“It must be opposed because”—
horror of horrors—
“point 2 would force the Government to give parliamentary time and prevent it from instructing its MPs on which way to vote.”
It goes on:
“This in turn would open the way for MPs and Peers to pass a new law.”
How shocking that that should be allowed to happen.
I regret to say that, even though the Labour Party and the Liberal Democrats are rightly allowing a free vote on this amendment, the Government are instructing colleagues to vote against it—despite my offer to the Front Bench to withdraw it in return for an undertaking to provide time in future for a Private Member’s Bill to allow Parliament to reach a considered view. Everyone knows that Private Members’ Bills, unless they are government handouts or are utterly uncontroversial, have little chance of clearing the parliamentary hurdles  unless they are given government time and assistance. It is fatuous for the Government to say that they are neutral on assisted dying while, at the same time, refusing to allow time for it to be considered. Without government time for private Members’ legislation, many controversial and important social reforms, such as the decriminalisation of homosexuality or the abolition of the death penalty, would never have reached the statute book. Passing by on the other side is not neutrality. It is a failure to come to the aid of the democratic process on an issue of the highest importance.
In Scotland, the parliamentary procedures for private legislation provide for proper public consultation and consideration by MSPs; this is probably the first time I have praised the Scottish Parliament in this Chamber. I am told that it is highly likely that the law on assisted dying will be changed north of the border—something for which my friend and political opponent, the late Margo MacDonald MSP, campaigned so bravely while herself suffering from a terminal illness—because Liam McArthur MSP’s private Bill enjoys strong public and parliamentary support. Of course, this opens up the possibility of people from England being forced to travel to Gretna Green for a less happy reason than today. Such an outcome would be impossible to defend if the UK Parliament had not even addressed the issue properly.
This must be serious because my noble friend the Minister, who is the equivalent of Kate Adie, is answering from the Front Bench. I am sure that he is equipped with the arguments; I remember them well. I remember the lines to take when Ministers are faced with a hopelessly weak argument against an amendment: “It is not the right Bill. It would create an unwelcome precedent. It is not properly drafted. The time is not right.” I hope that we will not hear them all again tonight. However, the Government are on record as saying that they will not stand in the way of Parliament deciding on the matter of assisted dying, which is a matter of conscience. This amendment would enable them to be as good as their word. To my colleagues on these Benches, I say this: help them to do the right thing. Ignore the Whip and vote with your conscience. I beg to move.

Baroness Henig: My Lords, the noble Baroness, Lady Masham, is taking part remotely. I invite her to speak.

Baroness Masham of Ilton: My Lords, many people are fearful and dismayed about the disastrous, inhuman situation in Ukraine. The threat of a nuclear attack and a third world war frightens many people. Added to this, many disabled and elderly people here in the UK are also frightened. Many vulnerable people feel that, if the assisted dying law is changed, they could be pressured into assisted dying because they feel that they are a nuisance and because they need looking after. Whatever the noble Lord, Lord Forsyth, says, this Bill should be about care, not killing. There should be compassion and palliative care for all those people who need it.

Baroness Henig: My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

Baroness Brinton: My Lords, the noble Lord, Lord Forsyth, has introduced his amendment very clearly, so I will be brief and say that I will also support him if he chooses to call a Division.
The majority of the British public support the legalisation of assisted dying. In a Populus poll of more than 5,000 people in 2019, 84% of respondents said they supported giving dying people the right to an assisted death. I am pleased that the noble Lord, Lord Forsyth, has managed to praise the Scottish Parliament system that has enabled my colleague Liam McArthur to have time for his Bill in its Parliament.
As the noble Lord, Lord Forsyth, has said, it is important to note that the amendment would not actually change the law on assisted dying. What it would do is to ensure that some proper parliamentary time is made available, as in Scotland, within 12 months of the Bill passing into law, to ensure that there can be a planned and proper debate with the wider public and with MPs and Peers that is just not possible in the Private Members’ Bill process that we have in our Parliament.
It is important to note that the amendment does not require government to support the legislation through Parliament, merely to ask for the time, and that this procedure has happened before with Section 16 of the European Union (Withdrawal) Act 2018. I hope that the Minister will change the Government’s mind on this so that the noble Lord, Lord Forsyth, does not have to call a Division.

Baroness Henig: My Lords, the noble Lord, Lord Howarth of Newport, is taking part remotely. I invite the noble Lord to speak.

Lord Howarth of Newport: My Lords, in moving this proposed new clause, superficially so bland, the noble Lord, Lord Forsyth, beckons us along a path which leads towards constitutional and moral anarchy.
What is dangerous constitutionally about this amendment is that it would undermine the way we do parliamentary government. Forcing the Government to lay a Bill before Parliament and to enable Parliament to consider the issue, as the proposed new clause requires, would be a coup. This Back-Bench amendment would usurp control of the parliamentary agenda from the democratically elected Government. In the last Parliament we saw Back-Bench MPs, with the collusion of Mr Speaker Bercow, contriving to set aside Standing Order 14(1), which gives precedence to business tabled by the Government, in order to substitute their own agenda on Brexit. I believe the noble Lord, Lord Forsyth, was very much opposed to that.
Parliament proceeds by precedence, and these are dangerous new precedents, as any noble Lord who sees their party as a party of government must surely agree. While it is for Parliament to interrogate government and hold it to account, it is not for Parliament to claim  for itself the role of the Government. Parliament is incapable of governing and it should not dictate the parliamentary programme. If Parliament makes exceptions to that principle to gratify a faction of its Members in either House, and if the principle that it may do so becomes established through reiteration so that the Government no longer control the legislative agenda, the ability of Governments to govern will suffer. Our system of parliamentary government is battered and unsteady as it is; we should not injure it further.
The moral anarchy that lurks in this new clause is that it would legitimise in a new way the taking of human life by other human beings. I readily acknowledge that the noble Lord, Lord Forsyth, the noble Baroness, Lady Meacher, the noble and learned Lord, Lord Falconer, and other proponents of what they call assisted dying are motivated by compassion and kind intentions. I profoundly believe, however, that their approach misreads human nature and that legislation to permit assisted suicide would create more suffering than it would alleviate. The offspring of this compassion would be a coarsening of our society and a diminution of the value we place upon life.
Some people make a moral case for assisted suicide on the basis of personal autonomy. I understand the appeal: I want, or I think I would want, such choice and control for myself at the end of my life. But that is not a good enough argument. Our responsibility is not just to ourselves, or even to those individuals we love the most, but to our community. For a community to be healthy, it must have norms. It has been a norm in our culture to place an especial value on human life. We reaffirmed that value when we abolished capital punishment. Since then, we have subjected our society to decades of laissez-faire ideology and chaotic individualism, and among the consequences of that have been a dissolution of community bonds and new harshnesses.
If we continue to dissolve our traditional norms, we are at risk that there really will be no such thing as society. As we look at our society now, at lethal child abuse and domestic abuse, at murderous assaults on women, as we look across the world at the millions consigned to death in the pandemic by the refusal of rich countries, including our own, to share intellectual property and technology to enable poorer countries to have vaccines, and as we witness increase discriminate mass killing in Ukraine and Yemen and genocide in Xinjiang, do we really think we should be preparing to sanction a new class of killing?
The new clause requires that a vote in Parliament on the intended legislation must be a matter of conscience. Let us examine our consciences very carefully indeed as we consider the proposal the noble Lord has put before us.

Baroness Meacher: My Lords, I support Amendment 170 in the name of the noble Lord, Lord Forsyth, to which I have added my name.
As the noble Lord made clear, there is no realistic prospect of a Committee day for my Assisted Dying Bill. This makes the point that the current procedures limiting Private Members’ Bills to Fridays do not enable important legislation such as the Assisted Dying Bill to reach the statute book.
The noble Lord, Lord Forsyth, introduced his amendment brilliantly. It leaves me only to reiterate that we are not discussing the pros and cons of assisted dying this evening. The House is expected to rise at 1.30 tomorrow morning. I hope for the sake of everybody in this House that noble Lords on both sides of the assisted dying debate will resist the temptation to get into such a debate—that is not as what this amendment is about. We are debating whether it is acceptable that there is no procedure at present to enable the Westminster Parliament to test the willingness of both houses to pass such a significant and popular piece of legislation. We know that not only Scotland, which the noble Lord, Lord Forsyth, mentioned, but Jersey and even the Isle of Man have procedures to enable them to pass an assisted dying law, and all those three are likely to pass such legislation within the next one to three years.
We therefore ask noble Lords: do we really think it is satisfactory that the Westminster Parliament is hamstrung without a procedure for Parliament properly to debate a Bill to legalise assisted dying for terminally ill people who are mentally competent and who are suffering unbearably? For Westminster to be upstaged on such an important and popular human rights issue by our much smaller neighbours is surely unconscionable. Amendment 170 from the noble Lord, Lord Forsyth, deserves our support.

Lord Cormack: My Lords, I oppose this amendment. Much as I admire my noble friend Lord Forsyth and fully understand the reasons why he has brought this before your Lordships’ House, it is not a good precedent to bind the Government in one Bill to introduce another a year or so hence. We should think very carefully about the constitutional issues.
We should remember Silverman and we should remember Steel: those Bills began in the other place—an elected House. An initiative of this sort should come from the elected House and not be imposed upon it by an unelected House. I do not think anybody would question my devotion to this House. I believe passionately in it. I believe passionately in an appointed House, as we are. I admire enormously the variety of expertise and experience that is in your Lordships’ House. However, we are not the elected House. I agree that it would be entirely reasonable in the elected House for time to be sought from government. The last time they debated this there was a fairly emphatic result, and it was not in favour of having an assisted dying Bill.
Much as we can admire the total sincerity of those who are committed to the principle of assisted suicide—I happen not to be of their number—it is very dangerous for us to begin in this House changing constitutional precedent by obliging government to introduce a Bill. Therefore, I urge your Lordships not to support this amendment.

Lord Lexden: My Lords, I have been informed that the noble Baroness, Lady Campbell of Surbiton, would like to participate in this debate remotely. I invite her to contribute.

Noble Lords: She is here.

Lord Lexden: Not remotely but present, which is very good indeed.

Baroness Campbell of Surbiton: My Lords, I am so thankful to be here tonight. It is a rare appearance but an important one and I am glad to be here in your Lordships’ House to oppose Amendment 170, which repeats the amendment that the noble Lord, Lord Forsyth, tabled in Committee. I apologise to the noble Lord for missing the first sentence of his contribution—I always enjoy his contributions and I am sorry to have missed the very first part.
This is a complex and highly contentious ethical issue. Opening the door to what is effectively assisted suicide would be a monumental change in the criminal law with potentially lethal consequences. If we get it wrong, it will result in some vulnerable people needlessly taking their own life.
The current Bill on assisted dying needs to be examined with the utmost care on the basis of highly informed opinion, robust evidence and a deep understanding of why hundreds of disabled people fear it. I do not think that we understand this cohort. I wish we did but we do not. We have seen a range of legislative developments in recent years in the UK and abroad, all of which demand detailed analysis.
Using this Bill to force the Government’s hand and the pace of deliberation on a matter specifically covered by an existing Bill is, I believe, as others do, a blatant manipulation of the parliamentary process. It sets a dangerous precedent and should be resisted. This is the wrong Bill, the wrong time and the wrong way in which to debate one of the most fundamental issues that we face as a society. I beg—yes, beg—noble Lords to reject the amendment.

Lord Falconer of Thoroton: It is a privilege to follow the noble Baroness, Lady Campbell, whose contribution to the debate on assisted dying over many years is the admiration of all. I pay tribute to her and I know that the House thinks that as well.
I strongly support what the noble Lord, Lord Forsyth, is proposing for the following reason. We are trying to deal with an issue of conscience in Parliament. Issues of conscience generally have a bad time in Parliament because the major parties are not interested in such issues. You have to fight under our parliamentary procedures in order for issues of conscience to get dealt with. I completely agree with the noble Baroness, Lady Campbell of Surbiton, that this is a complex and difficult issue, but it is one that requires parliamentary time and, above all, Parliament to address the issue and make a decision.
I cannot convey adequately the mess that the law is now in. The law does not have the stomach to be enforced. Nobody wants a decent person who helps a loved one to die because they are having a terrible death to be the subject of prosecution, conviction and a possible sentence of 14 years. The law has been stood on its head and the Director of Public Prosecutions has been given the power to say that he will not prosecute if certain guidelines are followed. That means that the most basic principle of English law is subverted. It is not the judge and jury any more who decide  whether you are guilty of the offence but the well-meaning and admirable Director of Public Prosecutions. If he says that you are not to be prosecuted, you are in the clear. If he says that you are to be prosecuted—remember you have assisted somebody to take their own life—you are guilty. He is making the decision. That reflects the way in which our society is trying to deal with the issue.
What we need is proper parliamentary time for parliamentarians to address this exceptional issue. I was a remainer, tragically, and was very much against all the strange ways in which Parliament operated. But this is an exceptional matter. The noble Lord, Lord Cormack, with respect, is not talking sensibly when he says that that we are sticking this matter on to the Commons. The Commons will have to decide whether they agree or not.
I urge this House to adopt the amendment, not because noble Lords agree or disagree on the issue of assisted dying but because they take the view that Parliament should properly address issues of conscience. Please do not be swayed one way or the other by the issues on assisted dying, because everybody knows that there are strong arguments in favour and against—I feel as passionately as those who are against. Address the issue on the basis of whether Parliament should be able to deal with issues of conscience.

Baroness Butler-Sloss: My Lords, it would be perfectly possible for someone in the House of Commons to raise this issue and deal with it there. What concerns me—I pick up what the noble Lords, Lord Cormack and Lord Howarth, said—is that this seems to be a constitutional issue. I am not going to say a word about the rights and wrongs of assisted suicide or assisted dying. However, I shall just read a few words of the amendment. It asks us to agree that the
“Secretary of State must, within the period of 12 months … lay before Parliament”
not just the possibility of a Private Member’s Bill being given time, which was what was suggested earlier, but a draft Bill. That is telling the Government what legislation they have to pass. This is a matter that transcends issues of compassion or whether one is on one side of the argument or the other, because what we in the Lords are telling the Commons is that they have to support us telling the Government to put forward a Bill with which they may not agree. But they do not have any choice if this amendment is passed. That Bill has to,
“permit terminally ill, mentally competent adults legally to end their own lives”.
The amendment is not asking the Government to please give time—I could understand that. It is telling, not asking, the Government to put forward a draft Bill in support of one side of the argument. Whichever side I was on, I would feel absolutely impelled to resist this amendment.

Lord Winston: My Lords, I have repeatedly opposed assisted dying and it is well known that I feel, and have felt, strongly about it. I also feel that this is quite a different situation. I do not want to argue my case here, but serious issues are raised by the amendment. I am not persuaded that voting for it would make a difference, because the Commons can still consider  what we have said this evening. However, it is clear—I completely agree with the noble and learned Lord, Lord Falconer—that we as a Parliament have to discuss this issue.
I remember, when I first came into this House 27 years ago, in the Prince’s Chamber there was a notice recording an Act of 1620, I think—under Charles I—that argued that we should not use intemperate language in the Chamber. In this situation, I believe this is inevitably important. I regret very much that the noble Lord, Lord Howarth, spoke in the terms he did. I do not think it is helpful to the argument. I think it probably destroys his argument to some extent. What the noble Lord, Lord Cormack, says is a very different matter—and I regard the noble Lord, Lord Cormack, as a friend. Above all, it seems that as a Parliament we have to discuss this, and this is something burgeoning in the public. Therefore, it is a duty to discuss this in Parliament. If we happen to introduce this Bill, which the Commons can then consider, whether it is passed at this stage or not, that would be utterly justifiable, and I support this amendment.

Baroness Mallalieu: My Lords, this amendment surely goes to something of importance to all of us in this House, whether we support assisted dying or not, because it is about the role of Parliament and the proper exercise of the duties of an elected Government. The Supreme Court has repeatedly said that Parliament, and not the courts, should consider whether in some circumstances assisted dying should be legal. But so far, this Government have fought shy of doing so either of their own volition or by giving Private Members’ Bills time. There is now clear evidence that the public opinion has changed and wants Parliament to face up to this question and express its will. Yet the door is effectively being shut in the face of that opinion.
Dying is surely an issue of general public importance as it concerns every single one of us. Yet this subject is consistently and currently being starved of the oxygen of time in Parliament in order for the Government to avoid a controversial topic. This amendment does not require the Government to take sides or promote a Bill themselves; it merely requires them to prepare and lay a draft to enable Parliament to consider any possible change properly. I shall support this amendment, and I would hope that noble Lords, whatever their views on assisted dying, do the same, because this amendment is essentially about democracy.

Baroness Davidson of Lundin Links: My Lords, I rise to support the amendment moved by my noble friend Lord Forsyth. I do not do so lightly, because in 10 years of parliamentary politics, despite sometimes being seen as a bit of a rebel or trouble-maker, I have never actually broken a Whip before, that I can remember. It does help that I was a party leader for eight years and wrote the Whip, but it is still quite a big step for me. But for me here tonight, I have to, because I cannot believe, or understand why, the Government have whipped this in the first place, particularly when the amendment from my noble friend Lady Sugg, which is equally an issue of conscience, tonight is not whipped.
The reason I cannot believe this has been whipped is the reason that has been given—that of neutrality. I am absolutely content for the Government to be neutral on the issue of assisted dying. That is not just defendable but completely understandable, but not allowing time for discussion is not a neutral act. When contentious Private Members’ Bills attract clear tactics from oppositional Members to affix a deluge of wrecking amendments to slow progress through the House, denying such discussion time is not neutral. This is a convention that previous Governments have understood, and they have acted. The decriminalisation of homo- sexuality, the repeal of the death penalty, the legalisation of abortion: none of these measures would have passed without the Government of the day allocating suitable parliamentary time for their debate and discussion. To deny that time here is not a neutral act. It is to guarantee that this issue is killed by procedure and killed by practice. It is a de facto opposition to change.
For these reasons, I will break the Conservative Whip this evening. I encourage all people, no matter which side of the argument they happen to be on, who want us to have the deep, broad and considered debate we need on an issue as important as this to do exactly the same. I support the amendment of the noble Lord, Lord Forsyth, and I urge him to press it.

Baroness Finlay of Llandaff: My Lords, I feel I have to remind the House that we have had 95 hours of debate in recent years on this topic; and the implication that we have not debated this is a misrepresentation. The noble Lord, Lord Forsyth, has asked us not to talk about assisted dying but then actually did talk about some aspects. We are being asked to test the willingness in both Houses, but I remind the House that the Marris Bill started in the Commons, was debated there and was defeated there by 330 votes to 118. That is where a Bill like this should start.
It is true that, historically, there have been major changes. Those have been in Bills that started in the House of Commons, when the public understood what they were about. The public knew what capital punishment was, and they know what homosexuality is. These Bills started in the elected House, and they then came to this Chamber. That has been our procedure.
I would, though, like to challenge the claim that there is overwhelming support among the public. I think it is questionable. In the poll, when asked a bit more detail, 57% of the public did not understand what assisted dying is; 42% think it is your right to stop treatment, which is already a legal right; and 10% think it is hospice care. Dignity in Dying has said it wants to have the largest record of public support, yet to date it has less than 0.5% of the population of England and Wales signed up to this list. So I do think we have to look at some of the claims being made and think about them.
Whatever noble Lords think about assisted suicide and euthanasia, this amendment would set a dangerous constitutional precedent for any Government. It is surprising that the noble Lord, Lord Forsyth, with his deep respect for parliamentary processes and Governments being able to govern, has taken this approach, because  this amendment would set a precedent enabling any Back-Bencher from any pressure group to disrupt a Government’s agenda. Does the noble Lord plan to bring judicial proceedings if his proposal is not tabled in a year? That is the criterion in the text of his amendment. A draft Bill leads to a Bill, assuming and forcing government support, before exploring evidence of the complexities of licensing doctors to provide lethal drugs.
We do indeed already have a Bill before us, and it is awaiting debate. The amendments laid are not vexatious. Based on the extensive evidence from abroad, they expose the problems with the proposals from the noble Baroness, Lady Meacher. Where assisted dying is legal, palliative care has dwindled, legislation has widened, the safeguards have been seen to fail, and non-assisted violent suicide rates rise disproportionately. Post-event reporting, as in her Bill, does not work because it relies on the clinician. I could go on, but I will not.
Yet surprisingly, no request was made for Committee until months after Second Reading, and no one seems to have sought to discuss the amendments that have been widely criticised by those who have spoken today. Some Members openly want the prognosis requirement to be dropped from the Bill to make legal drugs available on request. We have to at least know what the content of the Bill is even before we proceed. An 18 year-old with severe anorexia is already eligible under the Bill that is currently before the House. The answer to harrowing accounts of inadequate care is not to force the Government to draft a Bill that would allow doctors to supply massive overdoses of unevaluated lethal drugs to patients. Good, holistic, palliative care has been made a right in this Bill by this Government, and people should ask for it and insist on it.
This amendment is not the way to seek a careful analysis of the complexities of assisted suicide and euthanasia. It creates a constitutional headache for any future Government’s ability to govern. The procedure is to debate a Private Member’s Bill properly in Committee; and that Private Member’s Bill should start in the elected House.

Baroness Jones of Moulsecoomb: My Lords, I hate to disagree with the noble Lords who have spoken against this amendment, almost as much as I loathe supporting the noble Lord, Lord Forsyth, on anything. But, for me, this is a matter of democracy. Public opinion is constantly moving on this, and it becomes more and more supportive as the public understand the issues involved. It is partly the duty of the Government to explain exactly what it is about. Having a proper debate like this is something we should all support.
Personally, I want this on the statute book before I need it. I have five grandchildren, and I try to talk them all into pushing me over a cliff if I were to get too ill. As soon as their mothers told them that it was illegal, they refused me. The idea remains that this is something which many of us want for ourselves, because we fear being incapable. Therefore, I support Amendment 170.

Lord Hunt of Kings Heath: My Lords, I would like to put a point to the noble Lord, Lord Forsyth. He said that his amendment simply provides  time for Parliament to consider an assisted dying Bill. I note that proposed new subsection (2)(a) also says that the Secretary of State should
“respect that this is a matter of conscience”.
But a draft Bill is a draft Bill. It will be prepared by a government department; instructions will be given by solicitors, after consultation with Ministers, to parliamentary counsel; and that Bill will eventually be approved by Ministers in the relevant department and put before Parliament. There will be a Minister in charge of the Bill. Whatever mechanism is chosen—maybe a Joint Select Committee of both Houses—to consider the draft legislation, the Minister will be in charge and will be seen by the public to be driving through a Bill. If the noble Lord had said in his amendment that more time should be given for the Private Member’s Bill, I would have supported it. Businesses managers clearly need to take account of the obvious wish of this House to have more time to debate it—

Lord Forsyth of Drumlean: I do not want to prolong the debate but, for the sake of clarity, I will say that the issue here is that this is a complex subject—as has been pointed out. It is a Private Member’s Bill, and the Government would provide support for that. It is not a government Bill, and it is not being piloted by the Minister. This is clear from the amendment. It could not be, because the Government then would not be neutral, as they should be, on a matter of conscience.

Lord Hunt of Kings Heath: I am very grateful to the noble Lord for his intervention. However, his amendment says:
“The Secretary of State must, within the period of 12 months beginning with the day on which this Act is passed, lay before Parliament a draft Bill”.
In my book, a Minister laying before Parliament a draft Bill is in charge of that Bill.

Bishop of Durham: My Lords, I agree with those who have already spoken opposing the amendment. First, the amendment is not appropriate as a use of the legislative process accompanying this Bill through your Lordships’ House. There is a question of purpose. If opportunity for debate is the goal, we must underestimate neither the significance of the Bill of the noble Baroness, Lady Meacher, in October and the thorough, careful and considered debate, nor the possibilities of calling for Committee. I would also support that time being given in this House. There are important constitutional questions which arise if the amendment enacted by this House does in fact instruct the Secretary of State in the other place to propose and introduce a draft Bill—as the noble Lord, Lord Hunt, has just outlined. If that is not the case—and if the noble Lord, Lord Forsyth, is not advocating for this draft to be introduced—what is the purpose of the amendment?
Secondly, I am aware that the language of the amendment has some real problems. One example is “terminally ill”. We debated the importance of language at Second Reading of the Assisted Dying Bill. The phrase “terminally ill” is understood in a whole range of different ways in different parts of the world.  Is there any guidance offered on the definition or scope behind the language in the draft Bill attached to the Secretary of State’s instruction?
The complexity of the issue in question is so great—and the lives of the people who are facing a personal debate of this kind, and feel that they would be particularly impacted, are so important—that this cannot be how we legislate on their behalf. We are on Report, so I was disturbed that the noble Lord, Lord Forsyth, intervened when he did.

Baroness Noakes: My Lords, ordinarily I would not support a novel procedure which overrode the precedence of the ways in which we normally do business and in which the Government expect to direct how business is taken in both Houses of Parliament. But I have been increasingly concerned that the Private Member’s Bill processes, both here and in the other place, simply do not work. They do not work for controversial Bills. It is simple to thwart the progress of a controversial Bill both here and in another place—but particularly so in this House through the mechanisms which we have seen used.
This issue is so important: it is clear that there is strong body of opinion within the British public wanting to see this issue addressed in some way. We must find parliamentary time to make a proper decision on it. I accept what the noble Lord, Lord Hunt, says about the unusual nature of a Minister having to lay a draft Bill which is not government business. But sometimes things are so important that we must find practical ways through them. I believe that my noble friend’s amendment is a practical way through a very difficult problem, and I urge all noble Lords on my Benches to ignore the Whip.

Baroness Smith of Newnham: My Lords, in Committee, I asked whether the Minister—I think the noble Lord, Lord Kamall, was responding on that occasion—had thought about giving parliamentary time to the Private Member’s Bill. The proponents of the current amendment are suggesting that this is not about the Government bringing forward a piece of legislation, even though—as the noble and learned Baroness, Lady Butler-Sloss, pointed out—that is exactly what the amendment says. If the intention of the amendment is to request parliamentary time—and we really are looking only at proposed new subsection (2)(b)—could the Minister, in replying, consider whether parliamentary time could be given to the issue without damaging neutrality in any way? The amendment, as drafted, would require the Government to bring forward legislation in favour of assisted dying. An amendment which gives parliamentary time to the issue would be very different.

Lord Carey of Clifton: My Lords, I will make a brief intervention. First, I rise to challenge the view that all bishops and religious leaders are against assisted dying. I changed my mind some seven years ago.
Secondly, we are discussing the Health and Care Bill. It so happened that this week I received a letter from two doctors—husband and wife—from Colchester. I will read a part of it because they asked me to  intervene on their behalf. Their experience comes from within the National Health Service; they worked in the NHS all their careers. One of them says:
“I visited P a little more than two weeks before he died. Alone with me, he explained that he was beyond misery, from the pain of his condition and from the effects that drugs were having. The time had come, the patient asked, to request something that would allow him to slip away. The look of disbelief and horror as I explained that I could not do this haunts me still.”
The doctor goes on to say:
“The Health Service which has done everything it could to involve the patient in their care and comply with the patient's wishes waits until they are at their most vulnerable and incapacitated, to impose a course diametrically opposed to the wishes of the patient.”
The same doctor goes on to offer a personal story. His own father, an eminent scientist, had developed an aggressive cancer with distressing side-effects. He loathed what he was going through. The indignity of it was abhorrent. He struggled to the local railway station and walked under a train. The doctor recounts:
“Sadly, it was a slow train, and he took several hours to die. Still conscious, he had to argue with the ambulance crew not to treat his injuries so that he could achieve his desired outcome.”
I offer these stories, which come from recently retired doctors. They believe the time has come for a change in the law to allow rational human beings to slip away in peace. I changed my mind on this issue some seven years ago, and I know that I am out of step with my church, but I believe that those of us who take this approach are on the right side of history. Therefore, I support the amendment in the names of the noble Lords, Lord Forsyth and Lord Baker, and the noble Baroness, Lady Meacher.

Baroness Fox of Buckley: My Lords, the noble Lord, Lord Forsyth, made the accusation that lots of the amendments to the Bill of the noble Baroness, Lady Meacher, were a sort of Machiavellian plot to subvert the democratic process. I want to point out that I had tabled one of those amendments, about mental health, partly because I thought that that was our job here, that when a Bill was before Parliament, we followed it through—to every Bill that I have followed through here, there have been myriad, endless amendments. I thought that our role was to scrutinise proposed laws, to debate the merits and demerits and so on. I was therefore disappointed that there was no Committee stage of that Private Member’s Bill. So I do not accept the suggestion that those who put down amendments did so somehow to avoid debate; in fact, it was the opposite.
My general view on the problems of parliamentary and democratic process was best summed up by the noble and learned Baroness, Lady Butler-Sloss. I also feel queasy that there is a kind of subverting of the parliamentary process by an amendment on assisted dying or assisted suicide being put down on the Health and Care Bill. It is totally inappropriate. It is hijacking a Bill. Whatever else assisted dying and assisted suicide is, it does not contribute to improving anyone’s health. It requires ending a life; it is not a healthcare matter, and it will require a major change in the criminal law, so this is the wrong Bill.
However, I have every sympathy with the noble Lord, Lord Forsyth, and feel his frustration. I feel all the time that there are lots of laws I want to change; there are lots of things I want to change about the country; there are lots of times when I feel as though the public think one thing and the Government ignore them. What one therefore needs to do is to lobby the Government—the noble Lord probably has closer access to them than a lot of us—or, as maybe I would do, to organise a demonstration or a protest, unless the Government had got away with banning that by the time we got there. In other words, in a democracy, there are lots of frustrations that need to be expressed if you want to change the law. Using our position as unelected legislators to add an amendment to an inappropriate Bill seems to be completely wrong on a matter of such huge importance.

Baroness Hayman: My Lords, I am glad to have the opportunity to follow the noble Baroness, Lady Fox, because it is important to recognise that she is quite right. We should be able to debate all the amendments that Members wish to debate, in both Houses, on a Bill of this sort—a Bill which, as the noble Baroness, Lady Campbell of Surbiton, said, addresses one of the most fundamental social issues facing society.
However, I disagree that this amendment is nothing to do with health. The last days, weeks and months of your life, the healthcare that you receive, and the options open to you are part of the healthcare provided throughout the NHS and elsewhere. So I believe that it is appropriate to discuss this here.
It is a novel procedure. It is not a procedure that mandates the Government to support the draft Bill that would be brought in. The amendment is precisely designed not to do that but to ensure that a proper and full debate is held. I normally follow the noble Lord, Lord Cormack, closely and often agree with him, but I do not accept that we are imposing something on the other House by passing an amendment to a Bill which is going to have lots of amendments made to it and will go to the other place, where those amendments will be debated and accepted or not accepted.
Most of all, I support this amendment because it is now nearly 20 years since I served on the Select Committee on the Joffe Bill. There have been numerous attempts since then to resolve this most important issue. They have all run into the sand one way or another. Our legislature has not found itself able to produce a result that satisfies everyone that there has been full debate and resolution found to how we should go ahead as a society. In that time, 20 other jurisdictions have managed that task, because they have found a way of providing adequate time so to do. For those reasons, I support this amendment.

Baroness Greengross: My Lords, I want to add my support particularly for what my noble friend Lady Hayman has just said. This has gone on for a long time. I have been involved in it throughout my time as a Member of this House and I do not intend to repeat what I have said before. I want just to say that the amendment in the name of the noble Lord, Lord Forsyth, offers a useful way forward so that assisted  dying is given time in both Houses to be debated properly. It must be given serious consideration. Whether one is for or against changing the law on assisted dying, we all surely agree that this is a very serious issue worthy of serious scrutiny and debate. It is unacceptable that, once again, my noble friend Lady Meacher’s Private Member’s Bill risks being lost, due not to lack of support but to not enough time being allowed to take the Bill through all its stages.
Assisted dying is very much related to health and care, and it is appropriate that this amendment should be included as part of this Bill.

Lord Baker of Dorking: My Lords, this is the second occasion on which I have spoken on assisted dying in your Lordships’ House. Five years or so ago, I supported the Bill in the name of the noble and learned Lord, Lord Falconer, and voted for it. I did not speak on the Bill in the name of the noble Baroness, Lady Meacher, but I was ready to vote for it. However, as we know, the vote was not called because the opponents of the Bill feared that, if there was a vote, there would be an even larger majority in favour of the Bill on that occasion than there was earlier, because the arguments against assisted dying are shrinking year by year.
This House has now accepted on two occasions a Second Reading for a Bill to ensure that assisted dying is placed on our statute book. That is the political and democratic decision of this House, yet it has now been thwarted twice, and the thwarting is most extraordinary.
We managed to survive constitutionally in the 17th, 18th and 19th centuries without trying to kill legislation by tabling so many amendments. It was a device invented by Conservative Back-Benchers in the 1970s to prevent a Bill passing through the House of Commons that prevented the hunting of foxes by dogs. A small number of devoted hunters devised this trick. The Member of Parliament was Marcus Kimball; older Members might remember it. It was a political trick which has been used in this House on three occasions: on the Bill of the noble Lord, Lord Grocott, on hereditary Peers; on the Bill of the noble and learned Lord, Lord Falconer; and on the Bill of the noble Baroness, Lady Meacher.
I remind your Lordships that the only way in which we as Back-Benchers in the House of Lords can effect personal influence on social change is through Private Members’ Bills. There is no other way in which we can effect a policy—we are all controlled by the agenda of the Government—yet we are being denied this. The democratic choice of this House in passing the Second Reading on two occasions is very clear, and it is being thwarted. That is very unfair.
I told my Whip three weeks ago that I was going to come in and support my noble friend Lord Forsyth’s Bill and vote. He said, “It doesn’t matter; it’s a matter of conscience”. He confirmed that in an email to me last week and in a conversation I had with him on Monday. I do not believe my Whip was lying—it was the Government’s view—but suddenly the Whip was changed last night, right at the last minute. Somebody must have spoken to people in the House of Lords, because the view has been very clear since my noble  friend Lord Forsyth tabled his amendment. It was clear that the Government—a Conservative Government —were going to be asked to prepare a Bill on assisted dying and, in a reasonable amount of time, find time for it to be debated.
The great social reforms we have had in the last 50 or 60 years all started with the Government of the day being prepared to find time for them. The Wolfenden report in 1957 recommended the decriminalisation of homosexual activity. That was opposed by many Conservative Back-Benchers, yet the Conservative Government of the day made time for it to be debated. When David Steel produced his Abortion Bill, the Government of the day—I think it was the first Wilson Government—made time for it to be debated. Thirdly, when Roy Jenkins as Home Secretary introduced a Bill to abolish hanging, the Government of the day found time for it to be debated.
That is the principle, so I expected that we were going to have a free vote tonight. I am simply amazed that the Government have now suddenly changed the Whip. Someone has spoken to them. I do not expect the Minister to accept that, but somebody from the other House has certainly spoken to the Government and said, “We don’t want to be in a position to have to draft a Bill on assisted dying and find some time in the not-too-distant future for it to be debated”.
We are not suggesting that the Meacher Bill should come back and be debated in May or June this year, in this parliamentary Session, but there are other parliamentary Sessions in which it could be introduced: 2022-23, 2023-24 or 2024-25. If it has not been decided by the next election, I very much hope that all of the four major parties in our country—the Conservatives, Labour, the Liberals and the Greens—have a clear undertaking in their manifestos that, if they were elected, time would be found for the two Houses of Parliament to make up their minds whether they wanted assisted dying on our statute book. I am quite happy to leave that decision to the British people because, unlike the noble Baroness here, I happen to believe that the argument has moved decisively as far as the people of this country are concerned. There are now far too many people who have seen relatives or friends die long, lingering and miserable deaths.
The original argument against assisted dying was sanctity of life. I found it extraordinary that in the debate of the noble Baroness, Lady Meacher, not one of the Bishops or Archbishops addressed the sanctity of life. Other arguments are now put forward: the vulnerability of people who are dying, with relatives gathering around and wanting to polish them off—things of this sort, all of which can be addressed by amendments to the Bill.
I am very surprised that a Conservative Government should decide to vote against my noble friend Lord Forsyth. He and I go back a very long way. Thirty years ago he was the chairman of the Conservative Party in Scotland—that was when we had a Conservative Party in Scotland—and I was the chairman of the Conservative Party in England. I got to know him very well, and I can think of no one who more embodies conservatism in his whole mind and being than my noble friend. Whether it was a question of  lower government expenditure, lower taxes, greater freedom of choice on housing or greater freedom of choice for parents, he was there. Conservatism runs in his blood—he has the bluest of blood—and I think it an insult to him and a disgrace that the Whips on my side of the House have said we should vote against him.
I hope that this amendment will be passed and that this House will recover the sense that, without it being passed, your Lordships’ democratic choice, which has been exercised on two Bills, is being totally disregarded by a political trick. That is simply not right.

Baroness Hollins: My Lords, I do not understand why it is a conscience vote if it is not about the substance or the subject but somehow about parliamentary process. That does not seem to me to be a matter of conscience.
The point is that people want better care at the end of their life. The amendment to this Bill from the noble Baroness, Lady Finlay, is a game-changer. I wonder how many noble Lords understand that something has changed during the passage of this Bill. For the very first time, people will now be eligible and able to have palliative and hospice care at the end of their lives commissioned by the NHS. It is the responsibility of all integrated care boards to commission proper, good palliative care so that the poor care and poor deaths that people in this House are afraid of will be a thing of the past.
This is the wrong time to talk about introducing lethal drugs as a last resort. We should be looking forward with optimism and hope about how things have changed. This is also relevant to my noble friend Lady Meacher’s Bill. Noble Lords have questioned the motives of Peers who have tried to amend that Bill. It needed to be amended and scrutinised. My amendments were all about palliative care—this was before the game-changer of universal palliative care—being available before people are offered the only option of lethal drugs. If lethal drugs are the answer, why was this not an amendment to introduce lethal drugs to enable people to be assisted in their own suicide? Palliative care will reduce the supposed demand for physician-assisted suicide.
I think the statistics have been misrepresented. Only 10 US states have legalised physician-assisted suicide, despite the supposed success in Oregon. Maybe they have recognised that palliative care decreases rather than increases when lethal drugs are available. Some 200 attempts to introduce physician-assisted suicide in the United States have been defeated.

Lord Sentamu: My Lords, I do not want to detain the House long. The noble Lord, Lord Forsyth, told us that this is not to open the debate in favour of or against assisted dying but, as the debate has gone on, there has been an opening up of that debate. We have to look very carefully at what was given to us by the noble and learned Baroness, Lady Butler-Sloss, on the constitutional question. This amendment is not saying that the Government must find time to debate this matter but instructing the Secretary of State.
This is a revising Chamber. It is made up of unelected people telling the Government in the elected place that they must produce a Bill and it must be given time. That is my worry. My views on assisted dying are very clear. I will debate it whenever the issue comes back again, but the issue for me now is to avoid what was happening towards the end of Theresa May’s Government, when the Back-Benchers were trying to take control of government business. That led us into a mess.
I am not against speaking in favour of any Government of any colour, because I have never been a member of any party, but I want to observe how the liberalisation of homosexuality actually happened. Michael Ramsey, as Archbishop of Canterbury, began a debate in your Lordships’ House because of what had happened to Turing and many other people. He just thought: is it natural justice that consenting adults should actually be prosecuted and have to go through horrendous treatment, some of them facing horrendous stuff? The debate happened here and what was the result? It was the Wolfenden report. That recommended that this should be debated and a Minister of the Government, and Mr Jenkins on behalf of the Labour Party, joined in the debate and what happened? The law was passed. Where did it start? It started in the elected Chamber.
I have a real concern that we, as a revising Chamber, are not even considering a Bill that has actually come from the Government but instructing the Secretary of State to produce a Bill within a year of this coming into being and saying that it must be debated. Does this respect our position and why we are here? This is not revising legislation, at which all your Lordships do a fantastic job. Without your Lordships, the Bills in this country would be horrendous. However, let us not overreach ourselves and think that we can instruct the Secretary of State to bring this in. Who is the Secretary of State in this case? is it the Secretary of State for Health and Social Care?
May I please ask that we get another amendment or another Statement to give the House a Private Member’s Bill that needs to be given sufficient time to be debated properly? Also, other people told your Lordships that on 21 September 2015, there was full a debate in the other place.

A noble Lord: A long time ago.

Lord Sentamu: Noble Lords might say that it was a long time ago, but it was debated. It is not as if this has never been debated properly. It went through all the processes and unfortunately the Bill was lost. Is this another example of once something is lost, you bring it back again and again? I do not want to be like a particular German Chancellor who lost an election and said, “This is really wrong, we must change the people.” Friends, we are a revising Chamber. We need a bit of humility about our position, and should not think that we can instruct the Secretary of State to bring in a particular Bill because time has been lost.

Lord Ashton of Hyde: My Lords, I detect a sense that the House would like to hear from the Front Benches, but I know that all noble Lords have a right to speak and that the noble Baroness, Lady Grey-Thompson, is very keen to say something. I am sure  she will understand that the House wants to hear the Front Benches and that, if my noble friend wants to bring this to a vote, we should get on with it.

Baroness Grey-Thompson: My Lords, I have spoken numerous times about my opposition to assisted suicide for many different reasons. It is not, for me, about the sanctity of life. Not everybody who believes that the law should not be changed has strong faith. However, we are continually being asked to vote through the principle and think about the detail later. The devil is in the detail.
Detailed scrutiny is our role as a revising Chamber. The Commons has so many of its amendments guillotined. However, we have to take an issue such as this, which is about ending people’s lives, very seriously and we have to debate some of the detail. I know that the noble Baroness, Lady Meacher, feels strongly about this and I wish she had pressed much harder and much earlier for a Committee stage for her Bill. In an issue such as this, when we are talking about ending people’s lives, there should be hundreds of amendments, because it has to be debated properly.
I would like to briefly go on the record to thank the hundreds of people who have written in. We are really lucky right now that we live in a democracy and that people are able to freely express their opinions, whether we agree with them or not. Our role in the House of Lords is to deal with those people who write in. Lots of people from both sides have written to me. However, we must also be really careful in our language and not scare people into thinking that assisted suicide is the only option for them.
As a disabled person who sits in this Chamber with a red stripy badge, I have a huge amount of privilege. Many, many thousands—tens of thousands or more— of disabled people do not have privilege in respect of protection. This amendment and what it seeks to do will fundamentally change the political and societal landscape for disabled people. If people have not read it, they should look at the article by the noble Lord, Lord Shinkwin, this weekend about how disabled people are encouraged to think that they would be better off dead than live with an impairment. Even in this Chamber, we hear about things such as incapacity and incontinence and all the things that people fear. I push back on that, and I push back on the view that public opinion is overwhelmingly in support of this. On the Dignity in Dying website, 284,881 people have signed the public petition. On the Commons website, asking for a change in the law, 46,483 people have done so. That is not overwhelming public opinion.
I know the frustration of people who want to change the law. I can feel it; we hear it, and I admire the fact that the noble Lord, Lord Baker, says that we are a democratic Chamber. There are plenty on the outside who would not agree with that in terms of the way that we operate. This, however, is a constitutional matter. For all those arguing in favour of this tonight, I really look forward to them supporting my Private Member’s Bills asking for things such as good education, work, social care and access to trains, which are the things for which disabled people are arguing. This is not it: this is not the right time and not the right place. I do not support this amendment.

Baroness Walmsley: My Lords, I think the mood of the House is that the Front Benches—

Lord Shinkwin: My Lords, may I just be indulged by the House in following the excellent speech by my noble friend Lady Grey-Thompson? Exactly seven weeks ago, not just to the day but to the exact hour, I started to feel very ill. I was barely 36 hours out of the operating theatre after surgery that had gone incredibly well and I knew something was seriously wrong. By midnight I was in agony, my bowels totally blocked by the combined effects of the anaesthesia and the pain relief. By the morning, I was passing blood and my haemoglobin levels had plummeted. That was just seven weeks ago. It was at that point that a decision was made to transfer me by ambulance to St Thomas’ A&E so that I could have an urgent blood transfusion. I lived to tell the tale, but tell it I would much rather not have done. I would much rather forget the whole episode—the unbelievable pain, the helplessness and the acute sense of vulnerability. My family do not know any of this; I have not told them. I am hoping they do not read Hansard.
I share it with your Lordships’ House because I believe that my recent experience is directly relevant to Amendment 170. We have been assured that this is not about the merits of assisted dying, but noble Lords should not underestimate the magnitude of what is at stake in this amendment. This is not the start of some cosy conversation about a harmless, anodyne measure. The end goal is assisted suicide and the means is a Bill proposed in this amendment. If this amendment were passed tonight, I firmly believe that in years to come, we would look back and say that today—16 March 2022 —was a pivotal moment.
My question to the House is: if the amendment were passed, would I have felt any safer? Would I have felt any less vulnerable as I lay in agony only seven weeks ago? The answer is unquestionably no. In the culture to which this amendment would inexorably give rise, with its nuanced assumption that my impaired quality of life somehow made my life less worth living, would I still be here? I do not know.
We are summoned by our sovereign to this place, whether physically in person or remotely, precisely because it is our obligation and responsibility—indeed, our solemn duty—to fast-forward to the worst-case scenario and to pre-empt and prevent that worst-case scenario in law. I fear that the effect of the amendment would be the opposite.

Baroness Walmsley: My Lords, as the noble Baroness, Lady Grey-Thompson, rightly said, the devil is in the detail. That is what Parliament does and it is what the noble Lord, Lord Forsyth, is asking your Lordships to allow Parliament to do.
Like many families across the country, my family has had discussions about the substantive issue of assisted dying. Different views have been expressed and no one has fallen out, but it is not around our dinner table that decisions must be made about an issue as serious as this; that is for Parliament. I trust Parliament, and I do not think it should be—as the  noble and learned Lord, Lord Falconer, pointed out—for the Director of Public Prosecutions to make decisions about these issues. Assisted dying is happening and Parliament must decide how or if it should be done.
It has been suggested that this House should not instruct the Secretary of State to do anything. As we have gone through the Bill, we have asked the Secretary of State to do quite a lot of things; in fact, we have voted that the Secretary of State should do a lot of them. What happens to those amendments? They go to the elected House. I have great respect for the noble Lord, Lord Cormack, and I understand how important he feels it is that issues as controversial as this should be decided by the elected Chamber. Well, if we vote for this amendment, those issues will be decided by the elected Chamber. If this novel procedure of a draft Bill being laid before Parliament is used, I trust Parliament; there will be proper debate and I hope that what will come out of it will be a very measured piece of legislation that takes all the concerns into account. The game-changer that my noble friend Lady Finlay has successfully introduced to the Bill will be taken into account by the elected Chamber.
It is very important that people who want to have palliative care to ease their suffering at the end of life actually get it—everyone should get it; there should be no postcode lottery—but even in those situations there may be people who do not want it and instead want to do something else. It is for Parliament, not for my dinner table or anyone else’s around the country, to make that decision and to be given the proper amount of time to come up with something that I hope will reassure those who rightly have fears. They have fears because they do not know what Parliament will decide. If we give Parliament the opportunity, I am quite sure that even a draft Bill, however well drafted, will probably be amended as it goes through the elected House. What will come out at the other end will probably reflect public opinion—genuine public opinion, that is; I am not quoting any polls on either side—as they will have given serious thought to the issue and listened to everyone who wants or does not want this measure on the statute book.
We must give the elected Chamber the opportunity either to accept an amendment that we may pass tonight or to send it back to us, but at least we will have asked them to think again. This House does that very well. We ask another place to think again. I hope we will tonight.

Baroness Merron: My Lords, I have listened very closely to the many passionate, informed and often personal contributions from noble Lords this evening. This debate has inevitably been about not only parliamentary process and legislative approach but consideration of assisted dying. I thank the noble Lord, Lord Forsyth, for opening the debate on Amendment 170, which proposes, as your Lordships’ House is more than aware, a new clause to bring forward a draft Bill on what the noble Baroness, Lady Campbell of Surbiton, described as a complex and difficult issue.
However, for me, the challenge of this debate is encapsulated in the contributions in the middle of it. The first, from the noble Baroness, Lady Davidson,  was that not allowing time for discussion is not a neutral act. This was followed swiftly by my noble friend Lord Hunt taking a different tack, saying that allowing for this amendment is also not a neutral act, and it is that which your Lordships’ House has wrestled with this evening.
It is indeed a matter of profound moral, personal and legislative importance that we find ourselves dealing with in Amendment 170. The noble Lord, Lord Forsyth, will be seeking a Division and these Benches will approach this on free votes. It is a shame that this is not the case on the Government Benches. Your Lordships’ House heard from the noble Lord, Lord Baker, about the importance of principle, whereby matters such as this should be subject to nothing other than a free vote. I certainly share that view. I know that noble Lords will exercise their vote this evening with the greatest of care.

Earl Howe: My Lords, I must tell my noble friend Lord Forsyth that I am not with him on this amendment and nor are the Government. That has nothing to do with the issue of assisted dying, about which we each have our own views, but is about the proper process for bringing forward legislation and the roles and responsibilities of government on the one hand and parliamentarians on the other.
Governments are elected. The electorate then expect the Government to bring forward their programme of legislation, which Parliament then decides on. If alongside that process there is an issue that the Government do not choose to legislate on, but which happens to be close to the heart of an individual parliamentarian, that parliamentarian has the privilege of being able to bring forward a Private Member’s Bill for Parliament to consider. In each of those two legislative processes the roles, rights, responsibilities and privileges of the Government and of individual parliamentarians are separate. It is no more appropriate for a Government to force an MP or Peer to bring forward a particular Private Member’s Bill than it is for an MP or a Peer to force a Government to bring forward a government Bill. That includes a draft Bill. As my noble and learned friend Lord Mackay of Clashfern observed in Committee, draft Bills are brought forward by Governments only when there is an intention to legislate.
The Government have no intention of legislating on assisted dying; it is not part of our programme, nor was it part of our election manifesto. Equally, it is no part of our agenda to prevent an MP or a Peer bringing forward a Private Member’s Bill on assisted dying. The noble Baroness, Lady Meacher, has done just that because it is something that she feels strongly about. It is for her to persuade Parliament and the Government that her Bill is a good thing.
That is the proper process, and surely that is how it has to be. If it ever became possible for an MP or Peer to use a government Bill as a vehicle for obliging the Government to publish a completely separate Bill, even one on a subject which was in tune with the Government’s thinking, the due process of legislating would thereby be subverted. I ask noble Lords opposite how they would react if under a Labour Administration, an MP or Peer proposed to use a health Bill as a vehicle to oblige the Government to publish draft  legislation, the purpose of which was to place all NHS hospitals into private ownership—or one might find an MP trying to use a criminal justice Bill as a vehicle to oblige the Government to publish legislation to bring back capital punishment.
My noble friend might say, “Well, in that circumstance, it would be for Parliament to decide whether or not to accept such an amendment”—but that is not the point. The point is that if one House of Parliament were to approve such an amendment and the other House were to follow suit, Parliament would thereby usurp the role of the democratically elected Government. The noble Lord, Lord Howarth of Newport, and my noble friend Lord Cormack were 100% right: it is for the Government to say what their legislative programme should be, not Parliament.
As the late Lord Simon of Glaisdale might once have said, this amendment is constitutionally offensive and it should be rejected on those grounds.

Baroness Meacher: Before the Minister sits down, does he believe that limiting debate on a crucial human rights issue to Fridays—when, as he knows, certainly in the House of Commons, very few MPs are around, and in the House of Lords too, many Peers are not available—is an appropriate way to consider a matter of very great importance?

Earl Howe: My Lords, we gave a full day’s debate to the noble Baroness’s Bill. That is surely not ungenerous.

Lord Forsyth of Drumlean: My Lords, it is late; we have had a very good debate. I have to say, I shall long remember being accused of leading a coup in Parliament.
My purpose was very simple. My noble friend has explained the Government’s position very clearly. I say to my noble friend Lord Baker, who was very kind in his remarks about me, that the Chief Whip made it perfectly clear to me from the beginning what the Government’s position would be. It has been set out by my noble friend Lord Howe. However, there is a problem here. It is all very well for my noble friend to stand at the Dispatch Box and say, “Well, we have the private procedure, and we have the government procedure”, but on a matter of huge importance, Parliament is completely unable to reach a view. My amendment was really an attempt to do that.
There has been some nonsense talked, I have to say, about how we are getting above ourselves and that we are instructing the House of Commons. If this amendment is passed tonight, it will go to the House of Commons and, under our procedures, it will be for the House of Commons to decide.
I have made it absolutely clear to my noble friend the Chief Whip and the Front Bench that if the Government say, “We don’t like this procedure; we think it’s a bit too novel, but we’ll give a commitment that we’ll make time available at some point in this Parliament for the purpose of discussing this really important issue”—I agree with the points made by a number of people that it is a complex and difficult issue; that is why it needs time for everyone to put their point of view and for a result to emerge, which might  very well be a conclusion that we do not want to change the law—then I would withdraw my amendment. But, for some reason, the Government are refusing to do so. They seem to think that it is more important to discuss ending the lives of lobsters than addressing this hugely important issue of the end of life for people. There is time for the former, but not for this.
The Government are entitled to their programme, but having listened to the response, I would like to test the opinion of the House.
Ayes 145, Noes 179.

Amendment 170 disagreed.
Amendment 171 not moved.
Consideration on Report adjourned until not before 9.15 pm.

Ukraine Sponsorship Scheme
 - Statement

The following Statement was made in the House of Commons on Monday 14 March.
“With permission, Mr Speaker, I will make a Statement on our Government’s response to help those fleeing the conflict in Ukraine.
This Government and this House—indeed, everyone in the UK—continue to be in awe of the bravery of the people of Ukraine. They are victims of savage, indiscriminate, unprovoked aggression. Their courage under fire and determination to resist inspire our total admiration.
The United Kingdom stands with the Ukrainian people. My right honourable friend the Defence Secretary has been in the vanguard of those providing military assistance. My right honourable friend the Foreign Secretary has been co-ordinating diplomatic support and, with my right honourable friends the Chancellor and the Business Secretary, implementing a new and tougher  than ever sanctions regime. The Foreign, Commonwealth and Development Office and the Home Office have also been providing humanitarian support on the ground to Ukraine’s neighbours, helping them to cope with the displacement of hundreds of thousands of people—but more can, and must, be done.
To that end, my right honourable friend the Home Secretary has already expanded the family route. She has also confirmed that from tomorrow Ukrainians with passports will be able to apply for UK visas entirely online without having to visit a visa application centre. As a result, the number of Ukrainians now arriving in this country is rapidly increasing and numbers will grow even faster from tomorrow.
We also know, however, that the unfailingly compassionate British public want to help further. That is why today we are answering that call with the announcement of a new sponsorship scheme, Homes for Ukraine. I thank my right honourable friend the Home Secretary and officials in the Home Office, in my own department and across government for their work over the past days and weeks to ensure that we can stand up this scheme as quickly as possible. In particular, I thank my noble friend Richard Harrington, now Lord Harrington of Watford, whose experience in ensuring that the Syrian refugee resettlement programme was a success will prove invaluable in ensuring that we do right by the people of Ukraine.
The scheme that Lord Harrington has helped us to design draws on the enormous good will and generosity of the British public, and our proud history of supporting the vulnerable in their hour of greatest need. The scheme will allow Ukrainians with no family ties to the UK to be sponsored by individuals or organisations who can offer them a home. There will be no limit to the number of Ukrainians who can benefit from it.
The scheme will be open to all Ukrainian nationals and residents, and they will be able to live and work in the United Kingdom for up to three years. They will have full and unrestricted access to benefits, healthcare, employment and other support. Sponsors in the UK can be of any nationality, with any immigration status, provided they have at least six months’ leave to remain within the UK.
Sponsors will have to provide accommodation for a minimum of six months. In recognition of their generosity, the Government will provide a monthly payment of £350 to sponsors for each family whom they look after. These payments will be tax-free. They will not affect benefit entitlement or council tax status. Ukrainians arriving in the United Kingdom will have access to the full range of public services—doctors, schools, and full local authority support. Of course, we want to minimise bureaucracy and make the process as straightforward as possible, while doing everything we can to ensure the safety of all involved. Sponsors will therefore be required to undergo necessary vetting checks, and we are also streamlining processes to security-assess the status of Ukrainians who will be arriving in the United Kingdom.
From today, anyone who wishes to record their interest in sponsorship can do so on GOV.UK; the webpage has gone live as I speak. We will then send any individual who registers further information setting  out the next steps in this process. We will outline what is required of a sponsor and set out how sponsors can identify a named Ukrainian individual or family who can then take up each sponsorship offer. Because we want the scheme to be up and running as soon as possible, Homes for Ukraine will initially facilitate sponsorship between people with known connections, but we will rapidly expand the scheme in a phased way, with charities, churches and community groups, to ensure that many more prospective sponsors can be matched with Ukrainians who need help. We are of course also working closely with the devolved Administrations to make sure that their kind offers of help are mobilised. I know that all concerned want to play their part in supporting Ukrainians, who have been through so much, to ensure that they feel at home in the United Kingdom, and I am committed to working with everyone of good will to achieve this.
Our country has a long and proud history of supporting the most vulnerable during their darkest hour. We took in refugees fleeing Hitler’s Germany, those fleeing repression in Idi Amin’s Uganda, and those who fled the atrocities of the Balkan wars. More recently, we have offered support to those fleeing persecution in Syria, Afghanistan and Hong Kong. We are doing so again with Homes for Ukraine. We are a proud democracy. All of us in this House wish to see us defend and uphold our values, stand shoulder to shoulder with our allies, and offer a safe haven to people who have been forced to flee war and persecution. The British people have already opened their hearts in so many ways. I am hopeful that many will also be ready to open their homes and help those fleeing persecution to find peace, healing and the prospect of a brighter future. That is why I commend this Statement to the House.”

Baroness Hayman of Ullock: My Lords, I begin by warmly welcoming the noble Lord to his place; it is good to see him in this Chamber. He was an excellent Member of the other place and he is very welcome here.
Moving on to the Statement, any scheme that will help Ukrainians reach safety is welcome. However, we feel we need more information as to how this will work in practice to give desperate Ukrainian families the help and support they need at this truly terrible time. Since the Statement was made, we have had a letter from the Secretary of State, the right honourable Michael Gove MP, in which I was pleased to see that he says:
“Our aim, through this route, is to offer a safe, warm welcome to as many arrivals as possible, based on the number of sponsors.”
The announcement introduces a new website, which allows UK households to say that they would host refugees, but there is no way to connect these households to refugees in search of homes. It seems that only households that have details of a specific refugee are able to host them, leaving families unable to flee to Britain unless they have somehow found hosts.
In addition to this, there is still no material change to the process, which means that refugees will still need to apply for visas by completing a 50-page—I  understand—online form and uploading a number of documents. Yet the letter from the Secretary of State, in follow up, says that
“we want to minimise bureaucracy and make the process as straightforward as possible while ensuring the safety of all involved.”
I also draw attention to concerns raised about how refugees will actually get here if it is agreed—who will cover the costs and how will that be managed? We have concerns that individuals will not be able to properly sponsor a Ukrainian national’s visa until Friday.
I am pleased to see that there is promised financial support for local authorities. This will be an awful lot of work for them, so I thank the Government for that. However, we would appreciate further details on broader resettlement matters such as how healthcare, education, social care and so on will be managed and provided for those who will need them.
If the Minister will indulge me, I have a number of questions. Can the Minister confirm who exactly is eligible to sponsor a Ukrainian as part of the scheme? Do people have to be British nationals, or is someone with indefinite leave to remain also able to do so? Can the Minister confirm whether the £350 a month will be treated as income that could potentially affect recipients’ benefits?
I do not understand why the Government are not playing more of a proactive role in matching sponsors and refugees. Could they not match some of the cases with those who wish to help but perhaps do not know how to navigate social media? Can the Minister confirm who will be responsible for undertaking any safeguarding checks on sponsors? Will this be done by the Government or will it be part of the local authorities’ responsibilities? Will data about arrivals via the route be shared with local councils ahead of time? As much access as possible to data ahead of time will help local councils to provide proper healthcare and education, particularly for the children who are coming.
We also have a worry that there are still 12,000 Afghan refugees living in hotel accommodation, and clearly we do not want to find Ukrainian refugees in the same situation and the situation being exacerbated. So, again, a little more information about that would be helpful.
I have mentioned children. We know that a large number of the people requiring settlement will be, sadly, women and children who have escaped, often leaving their menfolk behind. We will have specific issues around nursery provision, childcare and education. Can the Minister confirm who will be responsible for ensuring that these needs are met? Will it be the Department for Education or local authorities?
I think we are looking for more clarity from the Government about their expectations of local authorities. It is great that there is financial support, but what are the expectations for delivery by local councils? Will there be support for, say, voluntary or faith groups, which will also have an important role to play? My final question is: what provision will be made for unaccompanied children? Will there be a specific scheme for them?
The main thing is that refugees arriving into the UK are treated with dignity, and provided with the accommodation and further support they are going to  need to cope with this terrible crisis, until Ukraine is safe once again and they are able to return home and work to rebuild their country. I look forward the Minister’s response, which will be his maiden speech, and I wish him well.

Lord Paddick: My Lords, I too welcome the Minister to the House and to the Front Bench.
Of course, we welcome in principle an unlimited scheme where UK residents can sponsor Ukrainian refugees, but Homes for Ukraine is limited by other schemes. First, the Government still insist that all Ukrainian refugees must have a visa, while all member states of the European Union are allowing visa-free entry. These refugees are in desperate need now, and a fast response is required. Countries bordering Ukraine are being overwhelmed and they need us to take some of the pressure off them. Why is the Government restricting the flow of refugees into the UK?
The Government cite security concerns for slowing things down, but the Irish Prime Minister was interviewed on the BBC’s “Sunday Morning” programme, where he said that the need for a humanitarian response to Europe’s biggest refugee crisis since World War II
“trumps anything as far as we’re concerned.”
Mr Martin said the view within the EU is that all borders should be open to Ukrainians for as long as Russian bombs and missiles are being targeted at civilian populations inside Ukraine. He went on to say:
“We can all see the humanitarian crisis, we do know that that can be exploited by certain bad actors, but our security personnel will keep an eye on that in a more general way.”
If Ireland can keep an eye on security issues once refugees arrive in Ireland, why can the UK not adopt the same approach? Bearing in mind that there are no passport checks between the Irish Republic and Northern Ireland and between Northern Ireland and Great Britain, how does the UK and Ireland having a different approach make any sense? The Minister in the other place talked about putting humanity first; the UK is clearly putting visas first.
Another bottleneck in the process is caused by sponsoring families in the UK having to identify Ukrainian nationals or families by name in order to sponsor them. How are older people without IT skills who are fleeing Ukraine supposed to identify themselves to British sponsors, let alone complete a 50-page online form to get a visa? I know that the Minister is trying to cut that form down, but is it not a fact that the most in need are the least likely to get to the UK quickly?
Another barrier to accessing the heartwarming generosity of British families is that the programme is initially open only to refugees who have known connections to the UK sponsor. The Minister in the other place said that
“we will … expand the scheme in a phased way”.—[Official Report, Commons, 14/3/21; col. 620.]
Can the Minister explain what the various phases are and when they will be in operation?
Another potential bottleneck are DBS checks for sponsors. There are already backlogs. What additional resources are the Government providing to ensure that necessary safeguarding checks are done in good time?  Some of those volunteering to sponsor will already have been DBS checked. What are the Government doing to match unaccompanied child refugees, in particular, with those who have already been safeguarding checked, rather than expecting these sponsors to identify the most vulnerable?
What consultation has taken place with local authorities on whether the £10,500 per refugee is enough to provide additional school places and child mental health support, which is often assessed by child psychologists working in schools, and the other range of services that refugees are likely need? The Minister in the other place said that the payment to sponsors of £350 a month would not affect benefit entitlement or council tax status, but would a single-person sponsor lose their single-person council tax discount? In short, where is the detailed plan for how this nice idea is going to work in practice? I know that the Minister wants to do his best, but we believe that the constraints within which he is being asked to operate are too restrictive.

Lord Harrington of Watford: I thank the noble Baroness and the noble Lord for their comments. I should point out that this is technically not my maiden speech; I am told that it is my first speech but not my maiden speech. I leave it to noble Lords to work out what that means, because I am not sure.
As many might know, I was offered this job because of my experience from the programme that we did for Syria. At the time, I was the first person to be a Minister in three different government departments at the same time. On my return to this hugely enhanced job—the two are not the same—I am doing my best, in the few days available, to get the team who successfully did the Syrian programme back into action. It is a bit like one of those bands from my childhood that, 10 years later, completely reforms with some different artists and some of the main ones. And if I slip into Commons terminology, I apologise. I realise that I may have just one excuse for doing that tonight, so I will try not to.
I will deal first with the subjects brought up by the noble Baroness, Lady Hayman. Basically, she requested more information about the scheme. I understand that. The questions raised by both the speakers are perfectly proper. No one is playing politics with this and I know that no one is trying to take advantage. We are learning quickly. I will explain the visa, because both the contributions come down to whether we need visas, why we need visas, why it is taking such a long time and what a bureaucratic performance this is when people are dying, suffering and living in appalling conditions.
When I was offered the job by the Prime Minister, the only criterion that I was given, as alluded to by the noble Lord, was a security one. It is my job to make sure that this is done as quickly and as humanely as possible. I know that no one in this Chamber or in the other place would question the fact that national security comes first, but that does not mean that we are obsessed by it.
The current situation is that people fill out a form. It is unacceptable that it is 50 pages and I have been through every page of it with the Home Secretary.  By the way, I do not think that anyone is trying to mislead, but it is slightly misleading to say that it is 50 pages because, on most of them, if you click yes, the page after does not come through. Quite why anyone historically, never mind a refugee, has to do the whole lot I do not know, but there will be a lot less of it by Friday and, shall we say, far more obstacles removed after that.
Nevertheless, a form has to be filled in on a mobile phone, tablet or laptop. This is for Ukrainian passport holders, who will download their passport. This is not in a visa centre, by the way; it can be done everywhere. Then it will be sent electronically to the Home Office, where we have a team that we are gearing up all the time. It is in excess of 100 people now and will be gearing up to be double that by the weekend. Very soon afterwards, the refugees will receive a response. I have to be a bit of a politician and waffly by saying “very soon afterwards”; I have set a target of 24 hours and it may be more if the team is so overwhelmed, but I expect it to come down and down. The only reason for that delay—it really boils down to this—is so that criminal record checks can be done from all the databases that the team has. It is no more complex than that.
The passport holders then get a PDF back, which gives them the right to get on a plane and come here. It is not as cumbersome as it was and they do not have to go to a visa centre. The visa centres are being kept open with enhanced hours for people who do not have documentation—vulnerable children and groups that we can spend a lot more time dealing with. I hope that I have briefly covered the visa point brought up by both speakers tonight. The noble Lord, Lord Paddick, summed it up as “fast response required” and I hope that I have gone some way towards that.
This is not being used as a tool to restrict the number of refugees who we are taking in. This is not like the Syrian programme, where the Prime Minister at the time, David Cameron, said, “This is the number of people we are taking in through a humanitarian vulnerability scheme”. By the way, there is nothing wrong with vulnerability schemes—please do not think that I am saying that—but this scheme is open to everyone who is Ukrainian to come in. It is not restricted in number.
I return to the points brought up by the noble Baroness, some of which were duplicated. There is some concern about the matching process: “But what if I don’t know anybody?” I understand that and it is perfectly right, but I will give a bit of background to the matching process. When I was involved in the Syrian scheme, the model for community sponsorship was Canadian. Ironically, with politics being what it was, the day I was due to go to Canada to see it was the day I was reshuffled to the Department for Work and Pensions. Luckily, the Civil Service correctly fought back and officials went and this is very much the scheme used. The community sponsorship scheme for Syrians and others worked in small numbers but this is nothing like that. This is a way of fast-tracking it.
The reason why the scheme worked slowly is that it was a proper, boilerplate exercise. Every single detail was known about the refugee before they took off to come to this country. Everything was preplaced, not just the accommodation but employment and everything  else. This is a mass-type operation. No one has come up with a better word than matching, but it does not mean that someone who has been forced to flee Ukraine will think, “I have to look on a list, but is anybody suitable?” We have been speaking extensively to NGOs in the last two or three days which will do that for them. They will have tablets, laptops and all that sort of thing to do it. It is not just one individual having to find another individual.
On the points made about safeguarding and related issues, perhaps I could combine my reply to the two questions. However, if noble Lords feel that the answers are not adequate, I would be happy to follow up by taking questions either here or elsewhere. If any noble Lord or noble Baroness would like to meet with me, I would be happy to talk them through this because we are learning as we go. A lot of the comments I have had from MPs and Members of this House have been useful in our thinking on this—particularly MPs because their constituents speak directly to them about it.
I will make a general point about local authorities, if I may, which leads into safeguarding. They are being paid £10,500 per refugee. I was asked by the noble Lord, Lord Paddick, how that was calculated. Was it done like this? For the sake of Hansard, let me say that I put my finger in the air, meaning “Was it just a wild guess?” It was done on the basis that we used for the Syrian programme. It is for all the wraparound services except education, which is done on a per capita basis. I do not have the figures to hand—well, I am sure I do in the file I have been given—but, basically, it is an amount per child depending on their age, a bit like with academies generally.
The local authority will be responsible for all the wraparound services, meaning the things that they would normally deal with. They include safeguarding issues. I will come on to DBS checks separately because they were brought up separately but, on other safeguarding issues, the eyes and ears have always been education for children, for example, as the first way of doing it. However, the question of social services, mental health services and primary care was brought up. Through its networks, the Department of Health has been in touch with GPs and other people to make sure that primary care places are available.
Turning to DBS, basically, the question is: do we have to do full DBS checks on people who will be offering sponsorship and people with accommodation? We took the decision that it has to be a two-phase thing. If we must wait for full DBS checks, it may be that we can speed them up. When I left the House of Commons, I decided to become a school governor. It took two months. I hope that it was not because I am on any naughty list, but that is the way the system works. Before allowing people into homes, we will do criminal record checks and get all the things that are easily obtainable online as part of the process before people are approved as sponsors. After that, it will be the local authority’s responsibility to do the full DBS checks. Related to that will be its duty to inspect properties as well. Obviously, this is all very new to us, so we do not really know much. I am sure that the vast majority of people mean well in offering accommodation,  but we have to have the back-up system of property inspection and everything else that we would normally have.
It takes care of some of the other questions if I say that the local authorities have been extremely co-operative. I started off over the weekend talking to organisations such as the LGA and other council groups but, today, we had a call with 200 council leaders and chief executives; at least, that is what I was told, but you can only get so many people on Teams. There were a lot of them; it was a call to arms for them. My second cliché is that they have stepped up to the plate—at least, they have told us that they have stepped up to plate. In my department, particularly regarding the Syrian refugee scheme, we were used to dealing with local authorities. They were our main conduit for the resettlement of people. The only difference in this case is that the full burden of providing accommodation will not be on them.
By the way, let me add this because it answers one of the noble Baroness’s points: we have spent a lot of time with faith groups, voluntary groups and others—for example, World Jewish Relief and Church organisations —because they will, we hope, be able to facilitate a big supply of accommodation through their members and their associated people.
On the subject of unaccompanied children, I have a problem. I have been discussing it today with a group of Ukrainian MPs, and I am seeing the Ukrainian ambassador tomorrow on this subject. It is the Ukrainian Government’s position—far be it for me to criticise them; the meeting with the Ukrainian MPs was very emotional—that we need their permission before bringing children here. They do not want children removed far away because of what may happen in the future when they are settled. They want them back with their families. I am working through these things.
I am trying to make sure I have answered everything in the brief time available. Will the single parent discount disappear? I can confirm to the noble Lord, Lord Paddick, that it will not. This is not being treated as income for benefits, or regarding school and university fees, by HMRC or anyone else. I believe my time is up. I hope I have answered the questions. If not, I am happy to answer them either formally or informally.

Bishop of Durham: My Lords, I hope the House will forgive me; Bishops do not usually go first. I declare my interest as a trustee of Reset. I offer the Minister welcome. I loved working with him with Syrians and we did loads of work together. Please will he pass our thanks to Paul Morrison and the team, who I know have worked almost without sleep over the last four or five days? It is great that that team is being brought back together.
The big thrust from churches and the voluntary sector as a whole is about when the next phase is coming in. We believe that individual sponsors are inadequate because people cannot do this on their own. They will need the support of their neighbours, family, friends and local clubs. Can the Minister comment on when phase two will move through? Noble Lords might like to know that there is a matching system on the website Homes for Ukraine run by Reset tonight.

Lord Harrington of Watford: One of the other things I have to adjust to in this House is that I cannot call him Paul anymore and I have to refer to him as the right reverend Prelate the Bishop of Durham. I thank him for his comments on Paul Morrison. I hope he will be Lord Morrison one day; he deserves it because he has given up his new career to come back to this. The serious point is: when are we going to get to the next phase? It will be very soon, but I cannot say when because we are launching this phase on Friday. It will certainly be done in communication with the Church. The Archbishop of Canterbury was one of the first people to come forward for the Syrian refugee scheme.

Baroness Finlay of Llandaff: My Lords, I congratulate the Minister on his new position and welcome him to the very difficult job he now has. I declare an interest as we are trying to sponsor a family ourselves and work through this with them. Can he tell me what will happen to those who have had to flee and do not have their documents with them—whatever those documents are—even though they may be known to the people wanting to sponsor them?
What is being done on the transferability of DBS checks? Many of us working in the health service or schools have been DBS checked. Are those going to be automatically transferred? Are the Government going to require every adult in the household to have been checked or will one be adequate as an interim to take things forward?
Have the Government issued a template to local authorities of issues they need to address, such as the ways of managing bereaved children? Many of these children will have left their fathers behind; many will not know what has happened to their fathers even if they have come with their mothers. Managing bereaved children has to be done right and it is not a question of just going “There, there”. They really need to be understood. Is that guidance going to local authorities at a national level as to resources, or is each local authority having to find it out for itself?

Lord Harrington of Watford: The noble Baroness, Lady Finlay, is very experienced in this field and has asked some very detailed questions. I cannot answer in detail the question about the transferability of DBS checks. I would much rather answer properly in writing. I hope she understands that just fobbing her off with a letter is not normally my way but this is not high level; this is a very detailed conversation. As far as issuing guidance to local authorities is concerned, we will be doing that. It cannot be left to a situation where some are better than others. On dealing with traumatised children, that will be part of the local authority’s duty.

Lord Young of Cookham: My Lords, I join others in welcoming my noble friend to this House and to his new post. I also commend him on his very well-informed and sympathetic response to the questions he has been asked so far after only a few days in the job. Can I press him on primary care? Many of those coming under Homes for Ukraine will be in poor health. How confident is my noble friend that they will have ready access to GPs and primary care services, many of which are already under some pressure?

Lord Harrington of Watford: My noble friend has not changed since the first time I was in the Commons, as he always makes a good point in such a kind way. The primary care thing is very important. As I explained before, we have been in communication with the doctors’ organisations. It is true that his former constituents and mine are finding it difficult to get appointments with GPs, given Covid and everything else, but on this—this is not a very House of Lords type of expression—we have to muck in. I know the GPs know that, and they will be given the financial resource to enable them to do that.

Lord Wigley: My Lords, I congratulate the Minister on a delightful non-maiden speech. I have three quick questions. First, will those who come and who want to work be able to do so immediately? Will they be given a national insurance number in order to do that? Secondly, in how many languages have the forms been made available? Thirdly, what will be the long-term position of the devolved Governments in Edinburgh and Cardiff? Will they be in charge of this indefinitely?

Lord Harrington of Watford: The noble Lord, Lord Wigley, has referred again to my non-maiden maiden speech. I just say to him to wait for the maiden speech and think what he wants. The forms are in English only but there will be translation guidelines for all of them. We are not asking for translations for the documents that need to be downloaded—for example, birth certificates and the other things that would be provided in a normal situation. As far as the devolved Administrations are concerned, the first meeting I had was with Nicola Sturgeon, Mark Drakeford’s representative and the head of the Northern Ireland Civil Service. As with the Syrian refugees, they have really stepped up to the plate. Although the conduit for this will be their local authorities—like any other local authority in terms of payment—the Scottish and Welsh Governments may well choose to be sponsors themselves. I am pleased with their response and have always found them an absolute pleasure to work with on the refugee front.

Lord Faulkner of Worcester: My Lords, the Minister will have gathered that this is quite a friendly place. The start he has made in the Chamber has been exceptional, and I look forward to many more exchanges in future.
I want to draw his attention to a letter that the vice-chancellor of the University of Worcester, David Green, has written to our Member of Parliament in Worcester, Robin Walker—who, of course the Minister will know—and to the Further Education Minister, local authority leaders and the right reverend Prelate the Bishop of Worcester. The vice-chancellor says:
“At the University, we have readied ourselves to be a reception centre for Ukrainian refugees. This is in addition to doing what we can to raise money, send goods and help the Ukrainian people in every way at our disposal. We have accommodation and all necessary supporting facilities other than medical, which we are sure can be arranged in co-operation with NHS colleagues.”
The Bishop and the Dean
“have made plain that there are many who will willingly welcome refugees into their homes.”
I wonder whether he will agree to a meeting, when he has a moment, with the right reverend Prelate Bishop of Worcester, the vice-chancellor and me.

Lord Harrington of Watford: I thank the noble Lord for his comments; I would be delighted to meet with him and them. I should say that we have been in touch with the various university organisations and I am seeing the relevant Minister, Michelle Donelan, to discuss this, but I am happy to have that meeting.

Baroness Wyld: My Lords, I welcome my noble friend to his new role. I cannot think of a better person to get to grips with one of the important jobs we are facing. I want to build on the question from my noble friend Lord Young of Cookham and ask about refugees who come here who will need to access public services. Those who take them in will need help to help them access those services. They will need signposting. The Government have a very good Government Communication Service. Can the noble Lord say a little about what help will be available to those hosts to make sure that they do justice to the role they take on?

Lord Harrington of Watford: I thank my noble friend Lady Wyld—my noble friend both personally and professionally—for her comments. On the authorities that are being involved in this, as I have explained before, it is a wraparound service and it will be done in different ways. For example, we are organising welcome centres, so that when people arrive at the airports and, for example, Victoria Coach Station, there are those who can help with the first stage of the services that she mentioned, so it is not forgotten. I hope it will be part of an integrated process. Obviously, it needs the involvement of all the different organisations. This is not central government saying, “This is what we are doing, and we are controlling it centrally.” We cannot; this is happening on an unprecedented scale. We have a lot to learn and there will be problems. I am not claiming that it is all perfect, but we are getting there. I found that comment extremely helpful and I will bear it in mind for everything we do.

Lord Alton of Liverpool: My Lords, I join others in welcoming the noble Lord, Lord Harrington, to his post. He comes with a very high reputation for the way in which he dealt with the Syrian refugee programme. I know that everyone in the House, from all sides, welcomes him to his new responsibilities.
I will ask him two things. The first builds on something that the noble Lord, Lord Paddick, asked about. He may have seen comments by Theresa May over the past few days and by the Local Government Association this morning about the dangers that young people, children and unaccompanied minors could face from people trying to traffic them or exploit them. I declare an interest as a trustee of a charity which works in that field.
Secondly, I want to ask him about sponsorship for programmes not in this country but in countries such as Moldova. Moldova has a population of 2.4 million and in just over two weeks it has already taken 300,000 Ukrainians—the equivalent of 2.4 million in the United Kingdom if they came here. Some 200,000 have gone to Romania and, of course, millions have now gone to Poland. Last week his noble friend Lady Williams was  good enough to have a short discussion about the ways in which we can help charities based in the UK but which do not receive match funding; they are not covered by the DEC programme. Will he have a conversation with her about how sponsorship can work, so that people do not have to travel too far away from the region if they want to stay in those neighbouring countries, and can they be enabled to do so?

Lord Harrington of Watford: The noble Lord, Lord Alton of Liverpool, characteristically makes very good comments on this issue. On his point about sponsorship overseas, I must confess that I had not thought of that. All our overseas efforts have been put into providing money and resources, and we can be quite proud of what we have done. I know life is not down to money; this is about human misery. Last weekend, when I looked at the numbers, we were, I think, the largest single country in that regard. That does not answer his question, but it does mean that we have resources on the ground to help with that sort of thing. But I will consider the point he makes because it is very valid.
On the fear of the child exploiters, people traffickers and general predators that appear in these situations, as they do in every situation, we are relying a lot here on the local authorities. We are relying on electronic methods initially but on the local authorities and all the services—medical services, schools and so on—to provide the eyes and ears we need. But I am worried about it.

Viscount Stansgate: My Lords, like every other Member, I welcome the noble Lord to the House and to the Dispatch Box. My question is not so much about the money that will be paid to families who take in refugees. Rather, do the Government intend to provide for those refugees something in their own language that will set out for them what we in Britain are going to provide, so that they know and can expect the type of help that the Minister has so helpfully outlined?

Lord Harrington of Watford: I thank the noble Viscount, Lord Stansgate, for his comments. For the Syrian programme we did a one or two-day induction programme before people got on aircraft to come here. We do not have the time and facilities to do that because of the scale. However, when people arrive at the airports and other ports they will be given a welcome pack in Ukrainian which will explain why they are here, how they are here and what services are available to help them. These people will be terrified, tired and exhausted and will need to know those things, and that will be in their own language. I hope to expand on that but that is what this situation is immediately.

Baroness Hamwee: My Lords, first, if Ukrainians who are already here are students or have a work visa, their visas will expire at some point. Have the Government thought about their position? One does not want them to fall into illegality and they could be subject to exploitation, as the noble Lord just said. However, they could also be helpful with the integration of the people coming here. Secondly—I realise that neither point may have crossed the Minister’s desk or his mind yet,  although clearly he is bringing a lot of imagination to this—I have a question on Syrians who have been recognised as refugees in Ukraine. I have heard—this may or may not be right—that they are being told that they need to make an asylum claim from the very start. That seems illogical and unhelpful. If the Minister cannot comment on it, perhaps he could take it away.

Lord Harrington of Watford: I cannot comment on the second point that the noble Baroness made because I do not know the answer. However, I will give it some thought and drop her a line, or perhaps meet with her if she prefers to do it that way. On the first point about Ukrainians who would normally lose their right to stay here because they are on a work permit that has run out, I assure the noble Baroness that nobody will have to leave this country because of that. That permission will be extended so that they will get the same benefits as all other Ukrainian citizens. I am not sure about the actual detail, but I can assure the noble Baroness that that will be the case.

Baroness Bennett of Manor Castle: My Lords, I join other noble Lords in welcoming the Minister to his place. The Statement says, “The British people have already opened their hearts” to the Ukrainians. That is something that comes as no surprise to me, as someone who sees the hashtag #RefugeesWelcome fill my Twitter feed very often. However, there are of course also refugees from Afghanistan, Yemen, Syria—which the Minister referred to—and many other places who are in need of a safe haven from war and persecution. I appreciate that we are at the very early stages of an enormous rush situation now, but there are people in the UK who know refugees and asylum seekers from other parts of the world and who would desperately like to sponsor them to come here. Would the Minister agree that it is very hard for the Government to say to them, “No, you can’t do that for this person you know who’s desperately in need of haven” when people are so keen to do that?

Lord Harrington of Watford: No one would disagree with the points the noble Baroness, Lady Bennett, makes. However, this is a new community sponsorship scheme for us. We have our work cut out with Ukrainians but that is in no way to disrespect people or to claim that people who are not Ukrainians and who are in a terrible situation do not deserve the support this country gives. My own grandparents were beneficiaries of this country’s attitude towards refugees. Ironically, they fled the Russians as well, in different circumstances.

Lord Sentamu: My Lords, I congratulate the noble Lord on his maiden speech. It is maiden because it is his first in the House, otherwise he is illegal and should not be speaking. I congratulate him on the way he dealt with a number of questions. I declare an interest as chair of Christian Aid. We are one of the beneficiaries of the public money that has been raised—£120 million. We are getting some of that because we already have people working in Ukraine as part of our NGOs. My second interest is as president of the YMCA, which is already working, particularly in Germany and in Hungary. By the way, the YMCA is bigger in Europe than in the United Kingdom and Wales. It is already working and trying to work out how to help.
The question that both organisations ask is: why have the Government called those community activities “sponsorships”? Why are they not welcoming people? I speak as someone who caused trouble for Idi Amin by opposing him for expelling Ugandan Asians who were citizens. I got into trouble and that is why I am here. When they were all expelled, the British Government provided aeroplanes to bring them over. There was no question of sponsorship. Then they asked in the communities where they were, “Can you help?”. Why do the Government not get the refugees in first and then we will be able to sponsor them?

Lord Harrington of Watford: I thank the noble and right reverend Lord, Lord Sentamu, for his comments. I know that he spends his life dealing with precisely this kind of thing. On the semantics of the word “sponsorship”, if we had had time to think about it perhaps we would have thought of something else, but I think most people know what it is. People are sponsoring people and are responsible for them. The Government are paying some money towards that—£350 per month—but people are effectively offering because they are kind and decent. However, if we have time to breathe and to change the name, after people much more creative than me have thought of something a bit more user-friendly, I should be delighted to do so.

Baroness Smith of Newnham: My Lords, I welcome the Minister to his place and congratulate him on his quick command of everybody’s titles. I cannot imagine where he is getting the information from. However, I should like to press him on his answers about language to the noble Lord, Lord Wigley, and the noble Viscount, Lord Stansgate. The Minister said that on arrival people will be given information in Ukrainian. He has kindly said that documents will not have to be translated any more but can the Government not work with Ukrainians based here to translate the forms so that people in Ukraine can fill in the form in their own language to make it as easy as possible for them?

Lord Harrington of Watford: I thank the noble Baroness for her comments on people’s names. Indeed, some days I cannot remember my own name but I seem to be good at remembering the names of people in this House. Yes, people should have a form in Ukrainian. It is not, in my opinion, best for them to have it by the side of the form that they fill in but, in the short time available, it is the best I can do. Ideally, I should like the form to be in Ukrainian. Also, although the Russian language is horrific to many Ukrainians, for many or some it is their first language.

Health and Care Bill
 - Report (4th Day) (Continued)

Amendment 172

Baroness Finlay of Llandaff: Moved by Baroness Finlay of Llandaff
172: After Clause 164, insert the following new Clause—“Dispute resolution in children’s palliative care (1) This section applies where there is a difference of opinion between a parent of a child with a life-limiting illness and a doctor responsible for the child’s treatment about—  (a) the nature (or extent) of specialist palliative care that should be made available for the child, or(b) the extent to which palliative care provided to the child should be accompanied by one or more disease-modifying treatments.(2) Where the authorities responsible for a health service hospital become aware of the difference of opinion they must take all reasonable steps—(a) to ensure that the views of the parent, and of anyone else concerned with the welfare of the child, are listened to and taken into account;(b) to make available to the parent any medical data relating to the child reasonably required to obtain evidence to inform the parent’s proposals for the child’s treatment (including obtaining an additional medical opinion);(c) to allow the provider of an alternative treatment that is being advocated by the parent to provide evidence, in person or remotely, to the mediation process and subsequently to the court;(d) to demonstrate the reasons that significant harm would be likely to be caused by the proposed treatment; and(e) where the two parties are unable to resolve their difference of opinion, to allow for a mediation process, acceptable to both parties, between the parent and the senior doctor with overall clinical responsibility.(3) Nothing in subsection (2) requires, or may be relied upon so as to require, the provision of any specific treatment by a doctor or institution, and in particular nothing in subsection (2)—(a) requires the provision of resources for any particular course of treatment; or(b) requires a doctor to provide treatment that the doctor considers likely to be futile or harmful, or otherwise not in the best interests of the child.(4) In this section—“child” means an individual under the age of 18;“health service hospital” has the meaning given by section 275 of the National Health Service Act 2006 (interpretation);“parent” means a person with parental responsibility for a child within the meaning of the Children Act 1989.(5) Nothing in this section affects—(a) the principle of the best interests of the child,(b) the law about the appropriate clinical practice to be followed as to—(i) having regard to the child’s own views, where they can be expressed; and(ii) having regard to the views of anyone interested in the welfare of the child, whether or not a person concerned with the welfare of the child within the meaning of this section.”Member’s explanatory statementThis amendment aims to ensure that disputes between parents and doctors will be able to engage effective mediation.

Baroness Finlay of Llandaff: My Lords, we now come to the very real problem that relates to the power differential between a doctor and the parents of a sick child. I am most grateful to all who have met me and discussed the amendment, particularly some senior paediatricians and the charity Together for Short Lives, and for support from the Charlie Gard Foundation in redrafting this amendment.
The amendment has been carefully redrafted in the light of comments made on the earlier version. Everyone I have spoken to has recognised that problems sometimes arise. In its 2018-19 review, the Nuffield Council on Bioethics observed common themes behind disagreements —communication issues, differing perspectives on what kind of risks could justifiably be taken, feelings of powerlessness for both parents and staff, and delays in seeking resolution interventions. Among the recommendations is mandatory communications training, as in proposed new subsection (2)(a) in the amendment, and the timely use of effective resolution interventions such as mediation, as in proposed new subsection (2)(e). When parents, as most do, have looked up their child’s condition on the internet, they often come across suggested treatments on different websites or by talking to medical contacts that they have. Clinicians can feel threatened by that.
When parents are worried, they can come across as angry or difficult in their attempt to get information or get something done. All too often, they are labelled as overanxious. Yet, is it normal to be out of your mind with worry if your child, whom you adore, looks as if they might die.
This amendment tries to provide a route for everyone to communicate better, and for the temperature to be lowered. It applies where there is a difference of opinion between the parents and the responsible doctor when a child is thought to be nearing the end of life. When staff become aware of a difference of opinion, the clinicians need to listen to the parents, and others concerned with the child’s welfare, who may have important information to inform thinking. Parents who want to seek a second opinion want to know the results of tests, such as radiology, for example, and, at the moment, they must go through a complex and sometimes slow process to access the information. Sadly, some parents only find out what was in the clinical record after their child has died. Of course, if there is any suspicion of child abuse, subsection (2)(b) would not apply, as it would be outwith the “reasonable steps” criterion.
Where another clinician from a reputable centre is suggesting a treatment, they should be asked to explain it, and the evidence base behind the suggestion, to avoid distortion of messaging—hence, subsection (2)(d) of the amendment. Clinicians, in explaining why they oppose a proposal, need to be able to explain to the parents what the “significant harm” in the proposal is. When taking any clinical decision, harms and burdens are weighed up against potential benefit. If a child is going to be taken into care, the test is whether it is of “significant harm” to leave the child where they are, rather than be taken into care. In some ways, this is similar, because the clinicians are being asked to show that it is significantly harmful for the child to pursue the parents’ proposal, rather than continuing with the current management plan—when it often involves withdrawing treatment and is likely to lead to death.
Some hospitals have excellent ethics committees to involve early. The Nuffield Council report recognises that there are very real difficulties in the concept of best interest when deciding not to treat, as it is often not clear to the parents why abandoning the hope of  improvement is in the interests of the child. In an overcrowded NHS, unconscious bias can skew towards wanting a service to clear beds, when prognosis looks poor. However, parents know that the child has no interests once they are dead. Nuffield recommends that the views of parents should be accorded considerable weight in decisions about their child.
When the two parties are unable to resolve their difference of opinion, such a case would now go to the court immediately. This amendment suggests that a
“mediation process, acceptable to both parties”
should be allowed when, and only when, earlier attempts at resolution have failed, as in subsection (2)(e). A mediation process would be between the parents and the senior doctor with overall clinical responsibility. It cannot be delegated to a junior in training or to one of the nurses on the ward. If mediation fails, then, as now, the case would proceed to court. The amendment is clear that no doctor or institution would be required to provide a treatment which they do not feel comfortable giving. This is the current law. The amendment is also clear that the overriding principle is the principle, as laid out in current law, of the
“best interests of the child”
being paramount. If the child is Gillick-competent, such an amendment would not apply.
Similarly, the views of others, such as a social worker or health visitor who knows the family may provide important information. As is the case now, that information must be listened to, as it may relate to some safeguarding issues or other information unknown to either the clinical team or the court. The early steps outlined in this amendment should improve the quality of communication between parents and the medical team, thereby decreasing the need to go to mediation. The mediation process is to try to decrease the number of cases going to court. I beg to move.

Lord Russell of Liverpool: My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

Baroness Brinton: My Lords, I have put my name to Amendment 172. I thank the noble Baroness, Lady Finlay of Llandaff, for tabling this improved amendment, with important changes since Committee, as she has very helpfully explained to your Lordships’ House. I believe that this helps to find a way to balance the views of the child’s parents and the child’s doctors, and it is reassuring that many of the stakeholders from different perspectives have come to agreement on this.
The amendment also makes it clear that nothing affects the principle of the best interests of the child. This means that no medical professional could ever be forced to provide a medical treatment that they do not believe is in the best interests of the child, and that any other provider of such medical treatment would have to provide evidence during the mediation that this would benefit the child.
Another key reason for the need for this amendment is that at the moment mediation provision across England is inconsistent. While there is certainly excellence, there are also some problem areas. Having in legislation  an independent mediation process made available at the earliest stage possible can help facilitate less confrontational conversations while supporting both sides in the argument.
The issue of parent-doctor conflicts will continue to persist frequently unless the Government can consider this amendment, and I strongly urge them to do so. If the noble Baroness, Lady Finlay, were to call a Division, we would support her on this, but I hope that the Minister will be able to provide some positive news.

Lord Russell of Liverpool: My Lords, the noble Baroness, Lady Masham, is also taking part remotely. I invite the noble Baroness to speak.

Baroness Masham of Ilton: My Lords, I have my name to Amendment 172, and I congratulate my noble friend Lady Finlay of Llandaff on her persistence on this important matter of mediation. It is a proven way of dismantling conflicts before they reach the courts.
Over the years, there have been some tragic cases when relationships have broken down between doctors and family members. When this happens in a hospital environment, parents can feel backed into a corner, with no alternatives. Mediation gives the opportunity for the parents to give their views and to hear the doctors’ views too at the earliest stage.
Ending up in the courts costs parents, hospitals and the Government hundreds of thousands in legal fees and causes avoidable distress and concern to all those involved. The only people who win are the lawyers. Parents have to live with grief and the decisions which have been made for their child for the rest of their lives if the results are not good. They want to know that they tried everything possible to give their child the best chance.
I feel that there should be adequate training for doctors, nurses and social workers in the values of mediation so that there is a team approach to treating a child in a life-and-death situation. I hope the Minister understands the need for this amendment and will accept it.

Baroness Stowell of Beeston: My Lords, it is always a great privilege to follow the noble Baroness, Lady Masham of Ilton. I too have added my name to Amendment 172 and commend the noble Baroness, Lady Finlay, for the way in which she introduced it. This debate could risk sounding technical and legalistic, but it is really about redressing an imbalance of power between doctors and parents when their child is desperately sick and at risk of dying and decisions are being made about how best to care for them.
I will not repeat all that I said in Committee, but my attention was drawn to this issue just over a year ago by listening to Connie Yates describe the ordeal that she and her partner Chris endured through the courts when the Great Ormond Street Hospital doctors disagreed with their decision as parents to seek alternative treatment for their baby. Theirs may be an extreme example of what it means not to be listened to or taken seriously by highly qualified professionals who, because they  know more, believe they know best, but it is all the more profound because, as parents, what they experienced was not right, and it certainly was not what they deserved.
While this kind of ordeal might be rare, the wider principle—ensuring that we are all taken seriously when we deserve to be—needs promoting with vigour by those of us who enjoy great power and privilege. We need to go out of our way to redress imbalances where we see them, because the inequalities and unfairnesses that people feel, which have driven the political realignment we have seen in recent years, will not be fixed by infrastructure projects or economic decisions alone.
This Government are clearly committed to levelling up, but one of the most important ways of us achieving that goal is cost-free because it is about mutual respect. People want and deserve mutual respect from the professionals and experts they rely on for all sorts of things, but especially in their hour of greatest need.
I am very grateful to my noble friend the Minister for the care and consideration he has given to this issue since Committee, and I will of course listen carefully to what he has to say when he responds to this debate. I should add that my noble friend Lord Howe is a great example of humility from anyone who enjoys status and privilege.
I also understand that the Government will be reluctant to legislate. I understand that principle—it is not normally the solution I would reach for—but the proposal in the amendment that the noble Baroness, Lady Finlay, has brought forward is really modest. The doctors are not losing any power. We are just ensuring that parents of desperately sick children are shown respect and taken seriously when it comes to discussing with doctors how to do what is best for their child. All it does is make sure that, if relations break down, the doctors cannot go straight to court and rely on yet more highly qualified professionals, to the exclusion of the families in such a desperate situation.
As she said she would, the noble Baroness, Lady Finlay, has listened to all those who raised legitimate questions in Committee and has changed the amendment to address their concerns. I sincerely hope that my noble friend the Minister feels able to accept it.

Lord Balfe: My Lords, my only previous intervention on the Bill came about when I read the proposed clause, and in my capacity as a trained mediator I thought that the original proposed clause was not very sound. The proposed new clause is a huge improvement on that, and I hope it will be looked on with favour. As the noble Baroness said, it is about evening up the power relations.
If you are in a hospital and dealing with anyone who is ill, but particularly small babies, it can be a very difficult experience. My daughter-in-law had two very small twin babies. Gathered around the incubator were one PhD and three decent BScs, and we did not know what to do. We felt quite powerless, but we also felt that it was very difficult to get the doctors to tell us what the prognosis was. In fact, the prognosis was quite good—they recovered and are now both in the school football team—but at the time there was on our  part a great sense of powerlessness and a feeling that the doctors did not feel they really needed to communicate with us. That level of powerlessness is what this aims to address.
It is about early access to independent mediation. The first qualification of a mediator is that independence. They will not get a result, and nor should they, unless they have the trust of both sides and unless both sides enter into it in a good spirit, looking for a solution. Finally, if they get a solution, it has to be one that sticks. That is why the amendment refers to
“the senior doctor with overall clinical responsibility.”
This cannot be a mediation where a junior member of the medical staff is sent along, where it has no binding effect and where the senior doctor looks at it and says, “I don’t like that; we’re not going to do that.” There has to be some sort of legislative backing.
However, as noble Lords will have seen, the amendment states:
“Where the authorities … become aware of the difference of opinion they must take … reasonable steps.”
It is all about getting consensus; it is about releasing medical data to both sides, and it is about ensuring that the doctors responsible for treatment are at least obliged to listen to any alternatives that the parents might wish to put forward.
When we last debated this issue, I advised—and indeed this has been done—that we knock out the financial provisions, because we thought that the Government would object and say, “We can’t sign a blank cheque.” However, clearly not all the people listened, because this very morning the Ministry of Justice released its Legal Aid Means Test Review, which states:
“We are proposing to increase significantly both the income and capital thresholds for legal aid eligibility, and remove the means test entirely for some civil cases. These include legal representation for children, and legal representation for parents whose children are facing proceedings in relation to the withholding or withdrawal of life-sustaining treatment.”
It rather shoots the government fox that was running around, does it not? It was said that mediation would encourage litigation, whereas now mediation will discourage litigation, because it will be in the interests of both the health service and the medical profession to make mediation work. In making it work, they will not have days and days in court, but they will have a chance of putting the case to a mediator—having been one, I can tell you that it is a lot cheaper than a barrister—and coming to an agreement without needing the great generosity of our Deputy Prime Minister, Dominic Raab, in offering to pay all these costs. I must say that I was surprised by that statement, but if anyone wants to read it, there are multiple copies in the Printed Paper Office, which is where I got mine.
I hope that the Minister will be able complement his colleagues in the Ministry of Justice by taking a positive attitude to curing this particular result. Otherwise, we will be in a position where the Department of Health and Social Care is saying no to mediation, but where we are now going to get free access to the law courts to run up huge bills. What the Ministry of Justice does not say is which departmental budget will pay for this concession. I would not mind placing a little bet as to which one it has in mind.
So I am asking the Department of Health and Social Care to save itself some money, thanks to the beneficent amendment proposed by the four noble Baronesses and supported by me. We are out to save the Government some money, to make it much easier and to build into the system a right for parents to have a more evenly balanced say in what happens to their child at what is a very difficult and distressing time for many of them.

Baroness Fraser of Craigmaddie: My Lords, I did not contribute to the debate on this amendment in Committee, but I did sit and listen to the contributions from around the House. What struck me was that in his characteristically sympathetic response, the Minister had not quite understood the purpose of the amendment and the problems it would solve. He stated that the amendment would place the views of parents and guardians above those of clinicians. I do not see that this is the case, especially with the revised amendment that we have before us. Unfortunately, it is a reality that parent-doctor conflict happens. I declare an interest as chief executive of Cerebral Palsy Scotland, and I have seen far too often the views of parents dismissed by clinicians. No matter how qualified parents may be, or what their role in life outside the hospital may be, they are consistently referred to only as “mum” or “dad”. Too often there is an imbalance of power with doctors, and too often parents are labelled as “difficult” or “sharp-elbowed”, as if wanting to do the best for your child is an irritant, and such parents should be grateful for what they get.
By the time a family is faced with palliative care, they will undoubtedly have been through the care of many clinicians: specialist, community, hospital and, potentially, hospice teams. The parents are therefore often the one consistent factor, and they are especially important when the child is too young or too ill, or unable to voice their own views. It is when parents feel they have not been listened to by clinicians that they resort to formal complaints or litigation. It is a last resort, but too often it is the only resort that is open to them. This amendment seeks to address this by giving them space for a formal coming together of all interested parties at an earlier stage, and so preventing costly and lengthy legal disputes. It does not place one party’s views above others; it does not, as outlined in proposed subsection (3), require the provision of resources for any treatment or require a doctor to provide treatment not in the best interests of the child. It simply ensures that there is a clear framework in these tragic, difficult cases to guide what happens next.
This amendment is designed to solve a problem currently faced by families and clinicians at moments of crisis. I urge the Government to consider it, and I will listen carefully to the response of the Minister tonight.

Lord Alton of Liverpool: My Lords, the House will want to move on quickly, so I will not make the speech that I intended to make on this issue, but I would very much like to endorse what the noble Baronesses, Lady Fraser and Lady Stowell, the noble Lord, Lord Balfe, and my noble friend said in their earlier speeches. I know Connie Yates and Chris Gard, who are the parents of Charlie Gard, who died in 2017  of mitochondrial DNA depletion syndrome. Indeed, I have entertained them here in the House, arranged meetings for them and travelled with them. I entirely agree with what my noble friend is trying to do. This will make mediation work; it will create a proper balance and equality of arms. No parents should have to face litigation in these often tragic and troubling circumstances, so this is a good amendment and I hope the Minister will feel he can accept it.

Lord Sentamu: My Lords, I was patron of Martin House in York, which is one of the amazing hospices that care for children and their parents. I was invited by the parents of a nine year-old, who was having a very difficult and trying time, to talk to clinicians, because they did not think that they were being heard. As we talked, it became clear that that was not true: the clinicians were on the side of the parents, but their language was not helpful. We had this amazing conversation, and as a result the needs of the child and the aspirations of both the parents and the clinicians matched, and we were able to get very careful care. What the noble Baroness, Lady Finlay, is trying to do is recognise that in most cases parents have good desires, and clinicians probably know more than they are willing to say but hold back because of the sheer pain and difficulty that they see on the faces of everybody, and another voice can help in these situations.
Should I call it mediation? No, it is a coming alongside. In my time as patron of Martin House in York, I had probably 20 such conversations. The new chief executive has been training other listeners. Without this, in the midst of sheer pain, people polarise when they should not. So I support this because, in my experience, it has opened doors and then the conversations become better.
What was amazing for this young boy called Paul is that the parents are now great supporters of that hospice. They are able to talk to other parents and say that mediation is the best way; please do not polarise when facing such deep problems.

Baroness Merron: My Lords, this eminently sensible amendment sets out various considerations aimed at ensuring that there can be effective mediation when there is a dispute over children’s palliative care. There has been considerable discussion to bring this amendment to its current iteration and I pay tribute to the noble Baroness, Lady Finlay, for her efforts around this, having already secured a meaningful amendment to ensure that ICBs must commission the palliative care services they consider appropriate.
Your Lordships’ House is aware that this amendment and debate come out of the heartbreaking situation of Charlie Gard and multiple other cases like his. I therefore know that this issue has to be handled and considered incredibly delicately, taking into account the best interests of the patient receiving care above all others.
Balancing the views of clinicians and parents is intrinsically and incredibly difficult, and particularly challenging to codify in legislation. This amendment is a rational measure to move towards achieving a  better balance and keeping matters out of the court, as the noble Baroness, Lady Finlay, referred to in her opening. We certainly support its intent and I therefore hope that the Minister’s response gives it due justice.

Earl Howe: My Lords, I first thank the noble Baroness, Lady Finlay, for having brought forward this important issue for debate and for introducing it in her characteristically informed and professional way. I assure her that I understand the issues she has highlighted and why she has done so. There is no doubt in my mind that the kinds of case that she has cited are extremely distressing and stressful for all involved, and can, on occasions, be contentious.
The Government agree that mediation is often a good route to take when there is such contention. Parents and clinicians should have access to high-quality, independent mediation schemes where they wish to do so. There are many mediation schemes available and we are very supportive of them.
The NHS already ensures access to mediation in many cases, and we strongly encourage it to continue doing so. But, at the same time, we need to ensure that those schemes are effective in the different contexts in which they are needed. Currently, organisations have the flexibility to offer mediation services earlier in a dispute or to prevent such disputes arising. They have the flexibility to tailor services specifically to the unique circumstances in which they are needed.
I hope the noble Baroness would agree that each case is unique. It is essential that everyone is able to have their voice heard, that there is a good understanding of different perspectives and that there is appropriate involvement of parents in decisions about the care and treatment of their child. Naturally, in that process, differences of opinion can and do arise.
The key to progress in this area is something deeply nuanced—human relationships. That is why I believe that, rather than legislation, our efforts are better directed at working together to develop systemwide solutions about how disagreements can be avoided or recognised early and, most importantly, sensitively managed. We need to ensure that in these difficult situations NHS trusts and staff are well equipped, well prepared and well supported to make that sure parents’ feelings and concerns are fully considered and supported, and that the relationship remains positive and constructive. We know that there are already examples of best practice and guidance but we need to do more.
To improve the outcomes of these difficult cases, we need to look at the whole process. We need to look at how best practice can be shared across the system to ensure that parents’ voices are heard throughout the process, not just in mediation, and how we can prevent disputes arising in the first place. In the rare cases when a dispute does arise, we need to focus on the quality of mediation schemes and not just prescribe that mediation is offered by default.
To look at how best we can embed best practice, training and advice on shared decision-making and dispute resolution across the system, the Minister for Patient Safety and Primary Care has agreed to chair a round-table event facilitated by the Nuffield Council on Bioethics. This will build on the work already being  done by bringing together key stakeholders to agree actions that support the creation of healthcare environments that foster good, collaborative relationships between parents and healthcare staff. I have also offered to meet Connie Yates and Chris Gard to hear their experiences and discuss how we can support better collaborative relationships between parents and healthcare staff. I hope this demonstrates that the Government understand the importance of this issue and that we are committed to addressing it.
It is the Government’s view—I say this with some regret—that putting this amendment or another in the Bill will not help improve the outcomes of the very difficult, rare situations in which an unresolvable dispute arises. This is because efforts need to be focused on a holistic approach to dispute resolution to improve the process as a whole. Merely allowing for mediation to be available at the end of a dispute will not do this; either party could refuse it and allowing mediation will not, we think, drive the careful, sympathetic and considered work with parents and carers that this topic so urgently demands.
I recognise that these are difficult matters, but I think progress will best be made through practical, down-to-earth work across the system and by bringing in a wide range of perspectives. This is what I am now offering and I therefore hope that, in reflecting on that offer, the noble Baroness, Lady Finlay, will feel able to withdraw this amendment.

Baroness Finlay of Llandaff: I am most grateful to everyone who has spoken. I realise that the time is late so I will try to be very brief in responding. I appreciate the offer of Nuffield to host another round-table event. I believe it held one recently and it had its previous inquiry. The sad reality, however, is that over recent decades of trying to teach communication skills, things have not improved as much as they should. One of the reasons is high staff turnover, which means you educate one group and it moves on. Yes, things have to be sensitively managed, but the role models come from the seniors. We are not talking about the vast majority, who are doing really well. The problem is that the people who are not doing well are the very ones who do not take up the education and do not want to change. I believe we have now got to the point where we need to send a very clear message and put this in the Bill. I beg leave to test the opinion of the House.
Ayes 112, Noes 107.

Amendment 172 agreed.
Amendment 173 not moved.

Amendment 174

Baroness Chakrabarti: Moved by Baroness Chakrabarti
174: After Clause 164, insert the following new Clause—“Global health emergency international cooperationIn the event of the World Health Organisation declaring a public health emergency of international concern (“PHEIC”), the Secretary of State must within three months—(a) initiate or otherwise support and implement proposals temporarily to waive elements of the Agreement on Trade-Related Aspects of Intellectual Property Rights (“TRIPS”) at the World Trade Organisation to assist wider global manufacturing of and access to health technologies;(b) waive such UK-registered patents, industrial designs, other intellectual property rights, and protections concerning undisclosed information relating to—(i) vaccines,(ii) medicines,(iii) diagnostics and their associated technologies, and(iv) materials,as necessary for combatting the emergency internationally; and(c) issue relevant emergency compulsory directions to enable the domestic manufacturing of generic and biosimilar products.”Member’s explanatory statementIn the event of a public health emergency of international concern, this new Clause requires the Secretary of State to support domestic and international knowledge-sharing, to combat the emergency.

Baroness Chakrabarti: My Lords, the aim of Amendment 174 is to learn from mistakes made during this pandemic and ensure that, in the event of a  public health emergency of international concern, our Government share and support others to share critical knowledge, data, research and intellectual property relating to vaccines, tests, treatments and their associated materials. By sharing this information and intellectual property we can scale up and, crucially, diversify the manufacturing of pandemic tools to ensure equitable access around the world, expediting our ability to end the emergency for all by winning the race against new variants.
Less than 10% of people in low-income countries have been double vaccinated. Lower-income countries are not prioritised. The status quo pharmaceutical model of supplying to the highest bidder means that low-income countries have to rely on the good will of high-income countries and companies to provide donations. Evidently, this has not proven effective in achieving global equitable access. Many low and middle-income countries therefore want to manufacture their own vaccines, tests and treatments so that they can have greater oversight of supply volumes, timelines for dispensing products and prices now and for the future. However, pharmaceutical companies have widely refused to share their technology openly. In addition, the United Kingdom, the EU and Switzerland have continuously blocked South Africa and India in their proposal to temporarily waive certain provisions of the Trade-Related Aspects of Intellectual Property Rights Agreement—the TRIPS agreement—on all Covid-19 tools, vaccines, tests and treatments.
Amendment 174 seeks to remedy this. It calls for the Secretary of State to support or initiate a temporary global waiver of the TRIPS agreement within three months of a pandemic being declared at the WHO. This three- month period is there to give pharmaceutical companies the opportunity and the push to make plans for how they will voluntarily openly license their products and engage in transferring their know-how to companies with established manufacturing capacity. This time period is in step with the recommendations of the Independent Panel for Pandemic Preparedness and Response.
The pharmaceutical industry is an immensely powerful machine, and we need to work with it. But as history has taught us, through the HIV crisis, pricing for cancer treatments, and now with Covid-19, it does not always do the right thing. As we speak the WHO’s mRNA hub in South Africa based at a biotech company called Afrigen has managed to reverse engineer Moderna’s vaccine. As Moderna made a pledge not to enforce patents during the pandemic, Afrigen are doing well in its development. The project has been significantly slowed down by Moderna and BioNTech’s refusal to share their knowledge with the hub. This is just one example. There are over 100 potential mRNA producers across Africa, Asia and Latin America who could be producing vaccines now, if only they had access to the know-how and data, and were not restricted by the fear of patent infringement.
Amendment 174 is about encouraging the industry to do the right thing and the Government to take action to protect global health and live up to the slogan “global Britain”. It is not just political rhetoric but epidemiological fact that none of us are safe until we are all safe. If viruses are left unchecked, they will mutate and this pandemic is far from over; cases have risen hugely in South Korea, China and here in the UK of late. Talk of Covid-19 becoming endemic does  not that mean it has disappeared. Malaria is endemic in many parts of the world, but it continues to kill hundreds of thousands of people every year.
This amendment will also initiate a great deal of cost saving for the NHS during pandemics. We are paying the highest recorded price for the Pfizer vaccine at £22 per shot. This amendment reaffirms our commitment to using in these emergency situations compulsory licences, one of the public safeguards in the TRIPS agreement to enable the domestic manufacturing of generic and biosimilar products, which would mean that any company within the UK with manufacturing potential could be making these vital medical tools.
Just today we heard that a draft copy of the waiver has been leaked, although it has been significantly watered down and reduced in scope. None the less it shows there is a global consensus that intellectual property monopolies are a barrier to accessing Covid-19 vaccines, tests and treatments. We need the Government to use this moment finally to do the right thing and support a waiver on all intellectual property covering vaccines, tests and treatments that can be utilised by all countries in the negotiations to come.
I also urge Her Majesty’s Government to use their influence as a faithful customer of Pfizer and Moderna to push them to share their technology with the WHO’s mRNA hubs and revoke the patents they filed on Covid-19 technologies. This amendment is about improving access to affordable life-saving health technologies for our NHS and worldwide during public emergencies. We can bolster pandemic preparedness and expedite our response to Covid-19 and future pandemics. I beg to move.

Lord Lexden: I invite the noble Baroness, Lady Brinton, who is taking part remotely, to speak now.

Baroness Brinton: My Lords, I have signed Amendment 174 in the name of the noble Baroness, Lady Chakrabarti. I thank her for introducing it and for making it clear that this aims for global pandemic preparedness. The World Health Organization set a target to vaccinate 40% of the world by the end of 2021. However, 92 countries missed this target due to a lack of access. Despite the funding from high-income countries to the WHO-run COVAX and Gavi schemes, low-income countries have remained at the back of the queue as high-income countries have been able to jump in ahead, using their money to get second and third doses for their own population.
Frankly, we need a better system for future pandemics. We need to understand that openly licensing newly developed Covid-19 technologies, waiving intellectual property rights and sharing the manufacturing know-how would allow more companies to begin producing life-saving vaccines, drugs and tests across the world. However, pharma companies have widely refused to share their technology openly. We also need to source other key critical control products, such as testing equipment, PPE and masks. Relying on too few suppliers in too few countries caused immense problems for the first six months of the pandemic, and again as subsequent waves hit those countries. In addition, the UK, the EU  and Switzerland continue to block South Africa’s and India’s proposal to temporarily waive certain provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights—TRIPS—on Covid-19 tools.
Despite regular pandemic exercises in this country, and despite previous experience with vaccines for other diseases not being shared with low-income countries, we have not learned the lessons. This amendment sets out what a Secretary of State should do within three months of the WHO declaring a public health emergency. I really hope that Ministers are prepared to help make progress on this issue. If not, and if the noble Baroness, Lady Chakrabarti, calls for a Division, we will support her from these Benches.

Lord Lexden: I now invite the noble Lord, Lord Campbell-Savours, who is taking part remotely, to speak.

Lord Campbell-Savours: My Lords, this is an important amendment. To me, it is the most important in the Bill. It concerns preservation of life in conditions of general pandemics. If you leave worldwide vaccine manufacturing programmes to the free market, you will never fully deliver. Profit will always trump the public good, unless the state intervenes in some regulatory form or another. This is basically why I am a Labour person.
With that in mind, it is clear that the more we are told that the current arrangements for licensing and manufacturing are necessary for reasons of quality control, the more I am convinced that this is not the only consideration in mind. There are other considerations —primarily the need to maximise profit. There is nothing wrong with profit if the justification is reasonable. It drives initiative and entrepreneurship. However, when there are wider issues involved, as in the case of a global pandemic which threatens the well-being of nations and the international economy, there must be a consideration of the wider public good and benefit. I am not convinced that, apart from the case of the AstraZeneca project, public benefit has been the driver.
In Committee, I set out in some detail a case wider than this amendment for worldwide licensing arrangements based on the original amendment of my noble friend Lady Chakrabarti. I remain confused by the Government’s position, which seems ever reliant on research and limited production at home, with volume production overseas. I would have thought that there are lessons to be learned about supply volatility from the case of oil from Russia. Equally, with both China and India leading the world in vaccine supply—at the same time as both countries remain reluctant to support us over certain areas of dispute and crisis in foreign policy—alarm bells should be ringing. I remain of the view that we in the United Kingdom should lead the world in this area of research, development, manufacturing, licensing and supply.
We are moving into an era of further pandemics as research-spawned accidental releases inevitably will reoccur, or perhaps they will not even be accidental in origin. There are huge foreign policy benefits to be gained arising out of being the world’s primary producer and licensee of these vaccines. When you help people, they remain indebted. That is the approach China is taking in many areas of its foreign policy.
I will give an example. The French Government funded my higher education in France 60 years ago. To this day, I remain indebted to France, with a lifetime feeling of obligation. This is often the case for foreign students. I believe that if we had been suppliers and licensees to the world over the recent period, in particular Africa and the third world, the payback would have been immeasurable, with huge implications for foreign policy.
I will exaggerate to make my case: suppose we had been supplier and licensee to China. Can noble Lords imagine what influence such beneficence would have had on Chinese public opinion and, perhaps ultimately, on Chinese foreign policy? A friend in need is a friend indeed—we should never forget that.
I appeal to the Government, even at this late stage in the current pandemic, to think long term, and create the vaccine supply, manufacturing and licensing programme that my noble friend Lady Chakrabarti is advocating. Her amendment seeks at least a temporary, time-agreed waiver. It is a start. I am using her amendment to argue a wider case, a new vision. Her excellent amendment puts in place a building block on which a longer-term strategy should be constructed. We should lead by helping others to help themselves. The rewards are inestimable.

Lord Russell of Liverpool: My Lords, I was happy to add my name to this amendment to give it a bit of cross-House balance. Like the noble Baroness, Lady Brinton, I am an officer of the all-party parliamentary group on coronavirus. In the last two years, we have had a bellyful of coronavirus; we have heard ad nauseum about the problems and the tragedies that it has created and encompassed, and that is partly what leads to this amendment.
It is self-evident that the United Kingdom, and most of the rest of the world, was unprepared. Countries that had experienced SARS, particularly in south-east Asia, had a better idea of what they were getting into. Frankly, however, for most of us in the West, it was the blind leading the blind. Looking in the mirror today—and accepting our failings, and the unease that we in the developed world should surely feel for largely having prioritised looking after our own—is for me, certainly, distinctly uncomfortable.
The aim of Amendment 174 is very simple: equitable access to affordable health technologies for all. One of the biggest challenges is how to deal with the exclusive intellectual property rights that exist in the healthcare sector. Only 7% of people in low-income countries have been double vaccinated. Only an additional 14% have had one dose.
Noble Lords should remember where the variants have come from. The exception, of course, is alpha, for which global Britain is responsible, so that is something that we can be proud of. Beta came from South Africa, gamma from Brazil, delta from India, and omicron is truly global because it started in about 10 countries simultaneously. The two countries that went it alone, rather proudly, in developing their own vaccines—China and Russia—have produced manifestly inferior vaccines, which have not been subject to proper, clinical peer scrutiny.
I give two examples of the problem we face. First, Pfizer’s new antiviral treatment excludes most Latin American countries, and generic versions—unless Pfizer  does something about relaxing its intellectual property—may not be available in those countries until after 2041. Secondly, Tocilizumab, an antiviral manufactured by Roche, which is based on UK government-funded research, is unable to be manufactured in countries with established production capacity because Roche is enforcing its patents in these countries. There is a global shortage of this particular treatment.
Tackling the complex world of healthcare intellectual property is not easy. In my past career as a headhunter, I worked with clients that were large, complex, well-funded, international pharmaceutical companies, so I know full well the level of intellect and resource that they put into their intellectual property defences. We must apply ourselves in a disciplined and determined way at an international level; this is a chance for Great Britain to prove that it is indeed global. As an aside, during Oral Questions this morning, some of us on the Cross Benches were playing a game where, every time somebody from the Government Front Bench mentioned global Britain, another notional £10 clinked into the pockets of the Cross-Bench Christmas drinks fund; this afternoon, we had a particularly fruitful Oral Questions. As a mantra, it is meaningless unless it has real content behind it.
We need to develop a rapid response plan for the next pandemic. We will demonstrate that we have intellectual and moral myopia if we fail to do it. In a nod to Amendment 170, which we debated earlier, we should not show that we are content to let the less-developed world suffer from what I would describe as unassisted dying. That is unacceptable.

Baroness Bennett of Manor Castle: My Lords, I rise briefly to offer Green support for this amendment, which I would have signed had there been space.
The noble Baroness, Lady Chakrabarti, referred to today’s report that a watered-down version of the India-South Africa proposal for a TRIPS waiver looks likely to go through the WTO. I quote Max Lawson, co-chair of the People’s Vaccine Alliance:
“After almost 18 months of stalling and millions of deaths, the EU has climbed down and finally admitted that intellectual property rules and pharmaceutical monopolies are a barrier to vaccinating the world.”
Bouncing off the comments of the noble Lord, Lord Russell, I think that the Cross Benches might find an even larger drinks fund if they go for “world-leading” as the key phrase to identify. The comment from Mr Lawson shows that, collectively, the world has done very badly throughout the Covid pandemic and done very poorly by the global south. If the Government want to be world-leading, they could leap in right now and accept the noble Baroness’s amendment.

Baroness Thornton: My Lords, I congratulate my noble friend Lady Chakrabarti, the noble Baronesses, Lady Lawrence and Lady Brinton, and the noble Lord, Lord Russell, on supporting and promoting this amendment. Its explanatory statement says:
“In the event of a public health emergency of international concern, this new Clause requires the Secretary of State to support domestic and international knowledge-sharing, to combat the emergency.”
I cannot see why anybody would object to that.
I would like to say one more thing. The former Prime Minister, Gordon Brown, has led this country on how one should respond to a global pandemic with his work at the World Health Organization on the importance of sharing knowledge, vaccines and technology across the world. This amendment is about the pandemic that is coming down the track as well as the one we are dealing with at the moment, so we on these Benches certainly support it.

Lord Browne of Ladyton: My Lords, I support this amendment. I do not intend to repeat the excellent points that have been made by others because the case in equity—and the case in our own interests—is absolutely compelling in my noble friend’s excellent amendment. However, for a short period of time, I do intend to test just how good the Government’s resistance to this is; I will do so by referring to the Minister’s own speech in Committee on this very amendment. I will ask two questions of the Minister; I hope that he will be able to answer them because, if he cannot, there is no resistance to this amendment.
On 9 February, on the ninth day in Committee, the noble Lord the Minister repeated the Government’s oft-repeated view on this issue when it has been debated in your Lordships’ House that
“the Government remain open to all initiatives that would have a demonstrably positive impact on vaccine production and distribution. However, we believe that waiving intellectual property rights would have the opposite effect. Doing so would dismantle the very framework that helped to develop and produce Covid-19 vaccines at the pace and scale now seen. It would risk undermining the continued innovation in vaccines and technological health products that is required to tackle a virus, especially as it mutates and evolves, so we believe that doing so would be a mistake.”
Our domestic experience of this is the AstraZeneca vaccine, which was produced with 97% of the funds coming from government or philanthropy and only 3% from investment. Can the Minister therefore say what is the data, other than assertion from pharmaceutical companies, that supports this conclusion that the Government have come to? There must be data to indicate that vaccine waivers have had this detrimental effect; otherwise, the Government are not entitled to come to this conclusion. Try as I might, I have never heard a Minister, when resisting this equitable approach to vaccines, ever explain the data to your Lordships’ House.
I turn to my second question. Later in that same speech, in his fourth paragraph, the Minister said that
“Research contracts afford greater flexibility and more powerful levers than the amendment”,
and went on to say that they can produce
“requirements around access to medicines in the developing world.”—[Official Report, 9/2/22; col. 1704.]
Can the Minister tell the House of any contract that the Government have agreed that has had that result? Has this alternative, which the Government pray in aid, been deployed by them to such an effect that it has significantly bitten into the unbelievably unjustifiable inequity in the share of vaccines around the world?

Lord Sentamu: My Lords, I was not going to speak, but I am driven to respond to what I have just heard. I first declare an interest as chair of Christian  Aid, which works in some 29 countries, most of which have experienced what I call vaccine inequality. We constantly get letters urging us to try to help.
As far as the British Government are concerned, in relation to some of those countries, the money and the way that they have tried to help—which must be acknowledged—certainly with AstraZeneca, there has been a far greater equity coming out. When we had the Kent variant, the Government were very quick to share that information with everybody else. What I think the amendment is asking is that, when the World Health Organization declares a health emergency, if we have information we should make it available immediately.
Secondly, on the question of equity, we have just had a big Commonwealth service in Westminster Abbey and there are particular people—noble Lords may not believe it—who come from those 54 countries of the Commonwealth who still look to the United Kingdom as giving them not only language but the ability to understand the sheer pressure of inequality. I would have thought that this particular amendment would help us to answer some of our supporters out there in the global south by saying that we are very serious, given some of the help that has been provided—though it has not gone far enough; the antivirals and all those drugs have not been given equitably. I therefore ask the Minister to realise that the issue is not whether we have or have not done enough; it is that, if there is a global health emergency—locally and internationally—the Secretary of State is in a better position sometimes to speak and to help those who are struggling and finding it difficult.
Nkrumah said that Ghana would not be free until the rest of Africa was independent, and I believe the same is true now. I have had my double vaccine and my booster, but I am not fully vaccinated until the rest of the world is vaccinated.

Lord Kamall: I thank all noble Lords who have taken part in this debate for the passion they have shown. I think we are all concerned by vaccine inequity—as noble Lords have rightly said, we are getting our third or fourth vaccines while some people have not had their first yet—but we also have to be clear how we get to this stage. It is easy to say, “We spent this much money on public research and that led to the vaccines”, but it is not as simple as that. It may have led to the research but that does not lead to the production of millions of vaccines that can be distributed worldwide. There is a clear difference between pure research and turning that into actual vaccines and, once they are produced, getting them into people’s arms. You can certainly deliver them to countries but they do not always reach the arms. We have heard stories of vaccines being thrown away because of a lack of distribution in particular countries.
The sharing of knowledge has played and will continue to play an important role in the rapid scale-up of Covid vaccine production. The UK Government are very committed to addressing vaccine equity on every front. As the son of people who came from outside the EU—not white, privileged Europe—I believe very strongly in global Britain.
The experience of the pandemic has shown that it is voluntary collaboration that has made real, positive impacts on vaccine delivery. The scale-up of vaccine production at record pace has been driven by more than 300 voluntary partnerships. This unprecedented collaboration around the world has meant that global Covid vaccine production now stands at nearly 1.5 billion doses per month. Voluntary partnerships such as AstraZeneca and the Serum Institute of India, and Pfizer-BioNTech and Biovac in South Africa, show what is possible if you work together.
The intellectual property framework has been crucial in facilitating this knowledge sharing. Indeed, the legal certainty it produces cannot be overstated. It gives innovators the confidence to form partnerships and continue investing in the innovative health products and technologies that have contributed so positively to our global pandemic response. The intellectual property framework similarly supports the production and dissemination of vaccines and other products across the world.
Yes, 97% of the investment in research is public funding, but research is not vaccines. There needs to be a whole chain from that pure research to scaling up and distribution, and universities cannot do that. Waiving intellectual property rights would dismantle the very framework that has facilitated this collaboration. It would undermine not only the knowledge sharing that has helped to develop and produce Covid-19 vaccines at the pace and scale now seen but the framework needed to support the development of new vaccines and treatments, should these be needed in future.
It should also be noted that the least-developed countries are exempt from implementing the Trade-Related Aspects of Intellectual Property Rights—or TRIPS—Agreement, meaning that they already have a de facto TRIPS waiver. In addition, the TRIPS Agreement already provides flexibilities to enable countries to achieve their public health objectives, and we fully support the right of these countries to use these where needed—but you have to build the capacity. Low and middle-income countries can access medicines in times of emergency through flexibilities that allow them to manufacture or import without the consent of the patent holder.
For these reasons, the UK does not consider intellectual property rights a barrier to supplying and improving access to Covid-19 goods. The noble Lord, Lord Russell, can put another £10 in the Christmas bag. Instead, we shall continue to be a visible champion of those elements of the intellectual property framework that support effective knowledge sharing.
The noble Baroness will be aware that we have contributed vaccines through the COVAX scheme—a partnership of the Coalition for Epidemic Preparedness Innovations, Gavi, the Vaccine Alliance, UNICEF and the World Health Organization—but we know that is not enough. As noble Lords have rightly said, we have to learn from what we have done during this pandemic. One part of my ministerial portfolio that I am very proud of is international relations and health diplomacy. A constant theme in my G20 and G7 Health Ministers’ meetings is how we tackle these vaccine inequities and learn the lessons that many noble Lords have rightly raised.
Last week, the British Government hosted the Global Pandemic Preparedness Summit to learn those lessons: to make sure that we brought together all our experiences as countries, learned from those and asked what we could do next time. I was very privileged to host a working lunch with several overseas Health Ministers, as well as Dr Richard Hatchett, CEO of CEPI; Dr Seth Berkley, the Gavi CEO; and Dr Tedros, the director-general of the World Health Organization, sitting next to me. One of the issues that came up in our discussions was, rather than developing and less-developed countries relying on donations via COVAX, how we ensure that, first, there is more local and regional manufacturing of vaccines through public-private partnerships and, secondly, that vaccines get into people’s arms as quickly as possible once they are manufactured or are imported into a country. We need to avoid those situations where vaccines were wasted because they were not stored or transported properly, or where there was difficulty distributing them once inside a country.
With international partners, we are looking at a whole range of issues and new technologies, such as new distribution methods. Some noble Lords may well have read about drones being used to deliver vaccines to certain remote areas. Before using these drones, it is all very well having all these vaccines in the capital, but how do you get them into people’s arms? We have to look at that area. Intellectual property rights are irrelevant here. The fact is that the vaccines are there but you have to get them into people’s arms. We have to train more vaccinators and we need better transport.
We agree that the vaccine supply must be matched by the capacity of health systems to deliver them, and we have been working to strengthen health systems around the world. Our recently launched health systems strengthening position paper sets out this Government’s determination to do more to build overall capacity, from policy through to delivery.
But there are other issues. Just as there are the vaccine-hesitant in this country, there are many vaccine-hesitant people in other countries. Our African vaccine confidence campaign is working with experts in countries such as Botswana, Ghana and Uganda to reinforce communities’ trust and build demand from the ground up. Once again, you can get the vaccines there but you have to get them into people’s arms. We have also been working to minimise constraints on supply chains, such as tariffs. This has been demonstrated by our sponsorship and promotion of the trade and health initiative as well as the unilateral measures we have taken, including tariff suspensions.
We have also provided support for the development of regional manufacturing capabilities. This includes technical support to develop business cases for the manufacture of vaccines in South Africa, Senegal and Morocco. We are working with the COVAX supply chain and manufacturing task force to champion other practical efforts to scale up capacity. We believe that we are doing lots of things with our global partners—with Gavi, CEPI and the World Health Organization.
To be honest, I am incredibly inspired by some of the work that I see going on. This is about building real capacity. It is about transferring knowledge and  technology and making sure that we have that capacity. It is about making sure that we live up to global Britain, in which I firmly believe given my own family history—not from white Europe, but from a global perspective. I believe very strongly in that. I believe that waiving intellectual property rights will not help overcome these challenges. I may be passionate about this but I feel very strongly about it. I feel strongly about global Britain. I feel very strongly about my distant relatives who come from developed countries and about my own history, my own heritage. I feel much more strongly about this than noble Lords may well feel.
This is the right approach. I am hugely encouraged by this international co-operation and the potential of new technologies to help. I would be very happy to continue to engage with the noble Baroness. I think we probably share the same passion for making sure that this happens. Given that, I hope she will consider withdrawing her amendment.

Baroness Chakrabarti: I am grateful to all noble Lords who spoke at this late hour, including the Minister. With respect, however, the numbers just do not stack up. I am so glad that the Government have now donated over 30 million shots, but these have almost all been AstraZeneca, which has lower efficacy against the now-dominant omicron variant. Moderna belatedly allocated a mere 110 million shots for a continent—Africa—with an estimated population of 1.3 billion people. Pfizer has allocated only 2% of its global supply to COVAX. We are just not getting enough shots to enough people, and so the variants develop.
I am grateful to everyone and I would happily keep speaking to the Minister, who is always courteous in his responses, but I really do think that it is time to test the opinion of the House.
Ayes 82, Noes 115.

Amendment 174 disagreed.
Amendment 175 withdrawn.

Amendment 176

Baroness Hollins: Moved by Baroness Hollins
176: After Clause 164, insert the following new Clause—“Mandatory training on learning disability and autism (1) In regulation 18(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (S.I. 2014/2936), for sub-paragraph (a) substitute—“(a) receive—(i) such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform, and(ii) in particular, training on learning disability and autism, appropriate to their role, as set out in the code of practice issued by the Secretary of State under section (Mandatory training on learning disability and autism) of the Health and Care Act 2022,”.(2) With regard to training on learning disability and autism, the Secretary of State must prepare and publish a code of practice (“the code”) containing guidance addressing—(a) the content of mandatory training and its co-production,(b) the appropriate levels of training required across staff roles,(c) the co-delivery of training,(d) the in-person delivery of training,(e) the accreditation of training,(f) the procurement of training,(g) the monitoring and evaluation of the impact of training, and(h) the implementation of mandating of training across regulated health and social care providers.(3) The Secretary of State must seek the participation of and consult such persons and bodies as they consider appropriate—(a) in preparing the code, and(b) in revising it.(4) The Secretary of State may not issue the code or any revision unless a draft has been laid before and approved by a resolution of each House of Parliament.(5) The Secretary of State must review the code every three years and lay the findings before Parliament.(6) In this section—“appropriate to their role” has the meaning given by the code;“autism” means a spectrum of disorders which start in childhood, the clinical manifestations of which include atypical social communication and social interaction and restricted, repetitive patterns of behaviour;“in person” means training delivered live, by people, in the presence of the trainee;“learning disability” means a disability which includes a significantly reduced ability to understand new or complex information or to learn new skills, with a reduced ability to cope independently, which started before adulthood, with a lasting effect on development.”

Baroness Hollins: My Lords, Amendment 176 proposes that guidance should be published on how training in learning disability and autism will become mandatory for all health and social care staff. The amendment has been altered from earlier stages to address concerns raised by the Minister and officials, both in Committee and in discussions following Committee. I am grateful to the Bill team, Department of Health and Social Care officials, Mencap and noble Lords who are supporting this amendment.
The unacceptable health inequalities that many people with learning disabilities and autism face, which have been worse during the pandemic, have been reported numerous times and I am not going to repeat them here. Nor will I repeat the circumstances of Oliver McGowan’s tragic death. His parents have been powerful advocates of mandatory training and persuaded Her Majesty’s Government to commit to introducing it. Her Majesty’s Government conducted a consultation and launched an ambitious pilot of the Oliver McGowan mandatory training scheme and the evaluation is due any day.
This amendment goes a step further because it would put in statute a policy that the Government have committed to undertake. It would create a code of practice that would consult on and set out how training will be scaled up across the country. The code provides a number of advantages compared to simply amending the Health and Social Care Act 2008. It intends that co-production and co-delivery are embedded from the start and this is achieved through a requirement for the Secretary of State to consult relevant persons in preparing the code and regularly revising it in the light of outcomes. These relevant persons must include those with lived experience.
Co-production and co-delivery should be uncontroversial, but campaigners are still having to fight for this. One of the concerns put to me is whether in fact there are enough experts by experience to contribute to training that would be provided to all health and care professionals. This morning, I told my son, who has a learning disability, about tonight’s debate. He said that he wanted other people to have the same opportunity that he has had to be able to train the staff in his GP practice, but training for trainers would, of course, be needed. So many people with learning disabilities and so many autistic people are keen to have work and yet the work opportunities are not there. Here is a brilliant work opportunity.
The amendment would require the Secretary of State to lay before this House and the other place the findings of a regular review of the code, which will be needed to ensure accountability and scrutiny and help to shape any revisions or changes required in the light of improvements or otherwise of the health and care outcomes for this group of people. Accepting the amendment would be a wonderful signal to campaigners, including Oliver’s parents, Paula and Tom McGowan, that the Government’s promises will be honoured sooner rather than later. I urge the Minister to accept the amendment.

Baroness Penn: My Lords, it may be convenient for the House if I clarify the Government’s position on the amendment at this stage. I am grateful to the noble  Baroness for bringing her amendment before the House today on the important matter of mandatory training on learning disability and autism for the health and social care workforce and I pay tribute to the work that she has done in this area.
The Government recognise that mandatory training on learning disability and autism will support the health and social care workforce to improve the quality of care and support provided to people with a learning disability and autistic people, thereby improving health and well-being outcomes. We remain committed to improving the lives of people with a learning disability and autistic people. That is why we invested £1.4 million to develop, test and trial the Oliver McGowan mandatory training with over 8,000 people in 2021. This will help to ensure that the training rolled out is meaningful and impactful. It is with great thanks to noble Baroness, Lady Hollins, for her determination and her collaborative work with the Government that I am very pleased to say that the Government would like to support the amendment put forward to introduce mandatory training on learning disability and autism.
While we are keen to support the amendment, we will be proposing to make some changes to ensure that it is fully workable and fits into the legal framework. It is likely that such changes will be introduced at the Commons consideration of Lords amendments stage. We have discussed this with the noble Baroness and we will ensure that we keep her fully updated with our proposals in this space. We hope that this commitment today sends a strong signal to people with a learning disability and autistic people, as well as their families and carers, that the Government are committed to addressing the significant and persistent health disparities that they face.
I could not make this announcement today without a special mention and thanks to Paula and Tom McGowan, who campaigned tirelessly for this cause. The resilience and commitment that both they and the noble Baroness, Lady Hollins, have shown have been inspiring. They should be proud of all that they have achieved for Oliver and for others whose lives have sadly been cut short.
To further emphasise the Government’s commitment to instilling real change for people with a learning disability and autism, I confirm our intention that all integrated care boards should have a named learning disability and autism lead and that NHS England proposes to issue statutory guidance on this matter to assist integrated care boards. The Government are supportive of this approach and believe that learning disability and autism leads on every ICB would act as a voice for those with a learning disability and autism in commissioning decisions. I commend this amendment to the House.

Lord Touhig: My Lords, I welcome the Minister’s statement—it really is very welcome—and declare an interest as a vice-president of the National Autistic Society. I also thank the noble Baroness, Lady Hollins, for her dedication, commitment and sheer endurance in pressing this matter of ensuring that those who support people with learning disabilities and autism are well trained. Training is essential if we are to help young people in particular to experience the kind of life that all of us in this Chamber take for granted.  With the right support, young people with learning disabilities and autism can enjoy that quality of life. I do not intend to detain the House, but I will just share with colleagues some of my experiences of young people who have succeeded because they have had the right support.
I met an 11 year-old boy with learning difficulties at a special school. He said, “You’ve heard I’ve got learning difficulties?” I said yes. “My brother has too,” he said. “He is five; he’s got autism. I’m helping my mother help him.” I said, “Oh, that’s good.” “I’m off to comprehensive school,” he said. I said, “That’s good. Are you looking forward to it?” “Yes,” he said, “and I’ve decided on my career.” I said, “What are you going to be?” “I’m going to be a High Court judge, and I can tell you now, if you come up before me, you’ll get a lenient sentence.” The point is that the school had really worked hard, but the head said to me, “He worked hard too at overcoming these problems.”
I met Max at a joint meeting of the All-Party Group on Autism and the All-Party Group on Apprenticeships chaired by the late Dame Cheryl Gillan, who pioneered the Autism Act. Max worked for a housing association. When I went there, I could see how hugely supported he was, as he had been as a youngster, in his job by his colleagues. At that time, he was an amateur actor and had appeared on “Victoria Derbyshire”. That was then—now he is an actor, a producer, a public speaker, an ambassador for the National Autistic Society and a recipient of the Princess Diana award, awarded to changemakers for their generation. He has had that success because he had the right support.
Finally, I mention Louise—I have not met her; I have just talked to her. Louise had some difficult times early in her life. “You don’t look autistic,” somebody once said to her. She said that she was often humiliated by her teachers and those in authority, and when she tried to work, she had meltdowns and could not cope. She got her first job in her mid-40s. She is now working for a charity supporting people with autism, and she said to me, “Now I’m given the space, and they let me lead and I can flourish. I’m helping other autistic people improve their lives.” With the right support, quality of life has been given to that woman, now in her 40s.
My point is simple: given the right support and encouragement, people with learning disabilities and autism can have the same quality of life as we all in this Chamber would expect for ourselves and our families. I welcome the Government’s decision to support this amendment. There is still much work to do, but it is going the right way. I thank the Government, and especially the noble Baroness, Lady Hollins, for pioneering the work that we are talking about this evening.

Baroness Merron: My Lords, I congratulate the noble Baroness, Lady Hollins, on bringing forward such a wise and sensible amendment, which follows a series of failings in the healthcare system, failings which might have been prevented if health and social care staff had had the proper training to meet the particular needs of those with autism and learning disabilities.
I consider this amendment to be about fairness—those with autism and learning disabilities may be treated as anybody may expect to be treated. I thank the Minister for her very positive response, and her and her team for  working so closely with the noble Baroness, Lady Hollins, and others to achieve the training of the relevant staff and to ensure a voice on integrated care boards. This is a fitting and lasting tribute to the memory of Oliver McGowan, and I am sure that it will always be regarded as such.

Baroness Hollins: My Lords, I am very grateful, and I know that Paula and Tom McGowan will also be very grateful—as will many people with learning disabilities and autistic people—to the Minister and to all those working behind the scenes for reaching this point and accepting my amendment, as well as for committing to include a learning disability and autism lead on integrated care boards.
I understand that some small changes may be proposed to ensure workability. I look forward to working with the Bill team and Department of Health and Social Care officials to ensure that these changes further strengthen the intention behind Amendment 176. I thank noble Lords for their support.
Amendment 176 agreed.
Amendments 177 and 178 not moved.

Amendment 179

Lord Moynihan: Moved by Lord Moynihan
179: After Clause 164, insert the following new Clause—“Office for Health Promotion(1) The Office for Health Improvement and Disparities is to be re-established on a statutory footing, as the Office for Health Promotion (“the Office”).(2) The Office is an independent advisory board to the Department for Health and Social Care.(3) As part of its duties, the Office must publish a National Plan for Sport, Health and Wellbeing.(4) The aim of the National Plan for Sport, Health and Wellbeing is to—(a) tackle preventable factors causing death and ill health in the UK;(b) demonstrate ways in which sports can help to strengthen social ties;(c) direct funding for sport;(d) include measures to promote physical access to the countryside;(e) identify ways in which schools and colleges are to be encouraged to develop closer links with local sports clubs;(f) include a fully costed National Facilities Plan and specific efforts to tackle discrimination and ensure there is a safe environment for all participants;(g) instil a life-long habit of sport and physical activity throughout the education system;(h) include a comprehensive approach to welfare, care and safeguarding including reports on enforcement of welfare, care and safeguarding standards in sports governing bodies;(i) lead national efforts to improve people’s health by tackling obesity, improving mental health and promoting physical activity;(j) establish a Physical Activity Observatory to act as a centre for independent research and analysis of physical activity data to input into the design of the National Plan for Sport, Health and Wellbeing;  (k) promote, encourage and raise awareness of the benefits of participation in sport for health, longevity, fitness, social interaction and wellbeing, and the other health benefits of exercise for all individuals, with the aim of preventing the onset of avoidable physical and mental illness and protecting people's health; and(l) promote clean athletes and the integrity of sport.”Member’s explanatory statementThis amendment implements recommendations 1, 2 and 3 of the House of Lords ‘National Plan for Sport and Recreation Committee’ report (session 2021-2022 HL Paper 113) which makes ‘The case for a national plan for sport, health and wellbeing’.

Lord Moynihan: My Lords, I thank the Minister for meeting yesterday with the noble Baronesses, Lady Morris of Yardley and Lady Grey-Thompson, the noble Lord, Lord Addington, and me to discuss this important amendment. We were all grateful for the sympathetic hearing we had. We are also grateful to the Bill team and particularly to Jamie Blackshaw, the lead of the physical activity team at OHID.
The Government immediately raised a number of concerns about our amendment. We readily accept the wishes of Ministers in the department that, instead of the office for health promotion, it should be called the Office for Health Improvement and Disparities. We completely understand the motivation behind that and totally accept it.
I will also respond to the second concern that the amendment could be read as if we were taking away the mandate of OHID, when we were talking about focusing on a national plan for sport and recreation and calling it the office for health promotion. That was never our intention, and it was good to have the opportunity to clarify that yesterday. The intention is that OHID should continue to undertake all its admirable functions in full. I hope it succeeds in that objective. Importantly, it should add to that accountability to Parliament for a national plan for sport, health and well-being.
The noble Lord, Lord Willis, chaired the National Plan for Sport and Recreation Committee, which recently reported on a national plan for sport, health and well-being. There was a good response to that from the Government and we were pleased when, yesterday, the Minister underlined his commitment to many of the recommendations we made. We certainly will not raise them again this evening.
We simply focus on the importance of hearing from the Minister about the health promotion task force. It may not be inaccurate to say that we have had, or appear to have had, a first win, as a result of the work of the Select Committee, in recognising that there needs to be a co-ordinating activity within government for sport, health and well-being to come together to tackle obesity, low levels of activity and the problems that so many children face coming out of Covid. We believe the health promotion task force may be able to achieve many of the objectives that we set out in the committee and that, ideally, should have ministerial responsibility. There should be somebody driving that.
Sport tends to be on the touchline of Whitehall when it comes to policy co-ordination. We must ensure that we have somebody of the calibre of, say, Tracey Crouch, who has done so much good work in bringing together sport, health and well-being, as New Zealand  does with its Deputy Prime Minister. It would be an admirable benefit to Government if they considered somebody of her ability, experience and respect to draw the work of the health promotion taskforce together.
It is important tonight not to rehearse any of the arguments we made in earlier deliberations on this Bill. High levels of inactivity, especially among women, ethnic minorities and disabled people, is of epidemic proportions in the UK. Nobody believes we can avoid the importance of cross-departmental policy co-ordination. Virtually every department of state now has an interest in sport, health and well-being. Unlike when I was a Minister when it was on the fringes of government, 30 years ago, today it is central to government policy. It needs the full weight of government behind it and that push must include education—we need to enhance the value of PE and teacher training time devoted to PE—as well as health, in addressing the obesity epidemic. It has to back up the outstanding work of the noble Baroness, Lady Grey-Thompson, in delivering a serious and robust approach to duty of care and safeguarding in sport.
I end by asking the Minister a number of questions. It looks as if the health promotion task force that is due to be established can achieve many of the objectives that the Select Committee and the four of us set out in earlier deliberations on the Bill. Is that the case? Does the Minister believe that the health promotion task force has the strength and remit to achieve those objectives?
Is it the Minister’s understanding that the Prime Minister will chair the Health Promotion Taskforce? If so—and this is the most important point for all of us on the committee, many of whom have been in sports policy for some 40 years—unless you have accountability to Parliament, you do not have the catalyst for change. With accountability comes the catalyst for change, and I simply ask the Minister to confirm that the Health Promotion Taskforce, covering the areas that the Select Committee has set out, will have teeth, not because it will be chaired by the Prime Minister but because it will be accountable to Parliament, so that Parliament can consider in detail the process, programmes, policy and direction in which we need to make significant advances to achieve improvements in wellbeing, health and sport, and the way that all three can work effectively together. I would like clarity on the commitment from the Minister, and I hope we will receive it this evening. I look forward to hearing from him, and I beg to move.

Baroness Morris of Yardley: My Lords, I support the comments of the noble Lord, Lord Moynihan. I do not want to repeat points that have been made at this late hour, but I wish to emphasise that the arguments about the importance of sport and well-being do not need to be made again. Everybody from all parties, right across the House, understand their importance and the consequences of not getting them right. The good will has been there for years, but the ability to transform it into effective action has not, and lots of well-intentioned efforts in the past have come to naught. That is what is driving the committee that met under the chairmanship of the noble Lord, Lord Willis, and I agree with the questions that have been asked.
For me, it is a case of not relying on a cross-departmental committee to run this project. It has not worked in the past, and there is no reason to think that it would work in the future. Is there seniority? Is there someone with clout who can bang heads together? Is there someone for whom it is a very important part of their job, and who knows they will be held accountable? I agree with the noble Lord, Lord Moynihan, that the Health Promotion Taskforce does seem to offer hope. Clarity on that—letting us know about its leadership, and the presenting to Parliament of an annual report for discussion—would allay many of our concerns. I look forward to hearing the Minister’s response.

Baroness Grey-Thompson: My Lords, I draw your attention to my interests: I am chair of ukactive, and I have a number of interests in this area. I also sat on the Lords Select Committee.
I too am not going to rehearse the arguments we gave in Committee, but all the names added to this amendment have been involved in this space for many years. We have all been through various iterations of this, and we should be talking about physical literacy and physical activity, and slightly less about sport. That might be surprising considering my background, but as the noble Lord, Lord Moynihan, said, we have an obesity crisis and a generation of young people who are more likely to die before their parents, and there are a number of conditions that can be treated. Frankly, we have been tinkering at the edges of this for way too long. There have been programmes and lots of initiatives that have had some success, but if we are serious about the NHS and the health of the nation, we have to do things in a different way. I feel like I have been talking about this for about the last 30 years—the noble Lord has had a slightly longer time in sport than I have—but I will be interested to hear the Minister’s response in order to understand how we can genuinely make a change and stop going round in circles on this important issue.

Lord Addington: My Lords, the last shall probably be quickest on this. We have all, as is agreed, said that we need to do something that is coherent. This has not been coherent. We have had committees that met once every full moon, provided everybody had had tea of the right quality that day; thus was their infrequency. Nobody was prepared to ensure that something that was inconvenient for one department was done to ensure that another department fulfilled it. There just was not anything. The Olympics did not manage to make them work together. We need coherent leadership and a price to be paid—accountability—for not doing it. If the Minister can give us that, we will have taken a major step forward. I would of course prefer the amendment that has been tabled, but I will take half a loaf any day over no bread. Can the Minister assure us that there will be leadership and that a price will be paid, publicly paid, for not doing it? Without that, as we know, this will merely become a report with somebody else saying, “They should have had a meeting about it some time”. Let us bin this. I am fed up with making that speech, even though it does usually get me out of a lot of trouble.

Baroness Blower: My Lords, this is a key opportunity to do something really significant for the health of the nation, from the youngest to the oldest, and  for all the groups we refer to as “excluded.” This is a key moment. If the Minister can respond positively to the questions put to him by the noble Lord, Lord Moynihan, he will be doing a very good job for the nation.

Lord Lucas: My Lords, I entirely support my noble friend Lord Moynihan when he asks for proper accountability. That is what drives the few examples of successful cross-departmental co-operation. One of the recent missed opportunities is Defra not picking up on aspects of the Glover report that deal with people getting out into the landscape. To make a difference to that, Defra has to care and it has to be brought to account, but there also has to be a good enough mechanism to ensure that if Defra does propose to do something, someone is going to fund it. That would certainly apply too to schools’ collaboration with local sports clubs. Parents up and down the land want that to happen. But how is that going to be afforded? How is that going to be made to happen? Who is holding the systems accountable? There has to be some system whereby accountability and interest flow through—as my noble friend said, ideally, to Parliament—to make that happen.
I have written to the Minister on perioperative care, which is another example. How does the NHS collaborate with all the other people who might provide the support required for effective perioperative care? They are not in the NHS; it does not work that way. You can have a system that just involves spending the money and ticking the box because that money has been spent; or you can have one with real accountability, in which people care whether you get the results and are measuring that, and who feed that through to someone with a central interest in things. So I am really going to listen to the Minister with great interest on this.

Baroness Merron: My Lords, I want to thank the noble Lord, Lord Moynihan—along with the noble Baronesses, Lady Morris and Lady Grey-Thompson, and the noble Lord, Lord Addington—for bringing forward this important amendment. It does strike me as strange that the UK does not already have a national plan in place to promote sport, health and well-being. If we are to tackle the acute obesity crisis in this country, a joined-up, forward-looking strategy at a national level is necessary. From these Benches, we support this amendment wholeheartedly. It offers huge potential to tackle obesity, poor mental health and a sedentary lifestyle in a joined-up way that sees people as whole people with different pressures and needs, but with the intention of focusing on prevention. So, I hope the Minister will be able to respond positively tonight.

Lord Kamall: I begin by thanking the noble Lords who initiated this debate tonight and my noble friend Lord Moynihan, the noble Baronesses, Lady Grey-Thompson and Lady Morris of Yardley, and the noble Lord, Lord Addington, for meeting with me yesterday, and with the Bill team and representatives from the Department for Education and DDCMS. What was really interesting was the experience that all four brought.  The noble Baroness, Lady Morris, talked about her experience in government and how it was sometimes difficult to get departments to talk to each other, even though they all seemed to agree. We had two former Olympians, who spoke about their experience of elite sport. But how does that translate into grass-roots sport? How do we make sure we get people active?
What was also really interesting was when we spoke about the 2012 Olympics. Yes, we had them and there was some legacy of redevelopment in east London, but they did not really lead to a legacy when it came to physical activity. How do we make sure we avoid the so-called Wimbledon effect? We all know that effect: around the time of Wimbledon, you cannot get a place on a tennis court, but a few months later it is simple to do so. How do we make sure this is long term?
If you are going to tackle obesity, yes, we can reformulate food and look at other issues such as taxes and negative externalities to discourage the intake of calories. However, you also have to burn off calories at the same time through activity. It does not have to be elite sport. We are not all going to be Olympians—like the two noble Lords here who were—but that should not stop you. All too often, what happens at school level is that if you do not get into a top team, you give up because you are considered not good enough. It does not matter how good you are; it is the activity that counts.
The Government’s recent response to the National Plan for Sport and Recreation Committee report addresses clearly, we believe, the recommendations made in this amendment. I hope that noble Lords will take some reassurance from what I am about to say and the fact that we take this seriously. The Government agree with the committee’s overarching recommendation on the need for an ambitious national plan for sport and physical activity. We are firmly committed to increasing sport participation and physical activity levels, and to ensuring that everyone has access to opportunities to get active. It should not just be about elite sport.
I can confirm that the Government will set out their forward-looking strategy for sport and physical activity later this year. It will look at tackling levels of inactivity as part of our plan for recovery from the pandemic. We hope that this strategy will provide a unified, cross-government approach to driving participation, integrating with Everybody Active, Every Day, the School Sport and Activity Action Plan, and Sport England’s new strategy Uniting the Movement. Of course, while setting out a cross-government strategy will be welcome, it is equally important to set out information on the implementation. I can confirm that the strategy will set out further detail on implementation, including how to harness such action across government and between departments.
The Government understand the concerns that noble Lords have raised and recognise that previous Governments of all parties have not always got it right. They tried—it was not for lack of trying—but it is about the implementation and strategies in this area. However, we believe that lessons have been learned and I hope that our approach will have the intended positive impact.
After the conversation yesterday with noble Lords, during the post-meeting debrief I spoke to the officials from other departments and asked, “How can we make sure that this is truly cross-government?” Let me assure noble Lords that other departments have also been looking at this issue. The Department for Levelling Up, Housing and Communities and the Department for Transport also have important roles in helping to create health-promoting and more active local environments. I reaffirm the Government’s commitment to working cohesively on such actions.
I also assure your Lordships that departments involved in the sport and physical activity strategy take their responsibility to co-ordinate extremely seriously. This is being led by DCMS while, more broadly, the Government understand the utmost importance of getting this right —and we must not lose that. That is why I am delighted by the leadership of the Prime Minister on the Health Promotion Taskforce, supported by the Cabinet Office. That will enable the Government to consider all options open to them. I will come to this in due course.
The Government recognise that it is important to provide updates to both Houses on the progress of the strategy and will publish arrangements for that reporting in the strategy. I also assure noble Lords that the Government invite and welcome the continued scrutiny of plans to address inactivity, to promote sport participation and to improve people’s health through physical activity. Undoubtedly, the relevant committees in the House of Lords and the House of Commons will have an interest in any future strategy and its progress. I am sure noble Lords will also want to continue to ask Questions of Ministers.
We recognise the deep experience of noble Lords in this area and I know that that interest extends to the other place. Only last night, my honourable friend Gillian Keegan, the Minister of State for Care and Mental Health, responded to an adjournment debate on physical activity and health. On that point, I reiterate and acknowledge the benefits and importance of promoting that. We know the gains made in activity levels in some key populations, including women and older adults, before the pandemic have now been reversed, and the Government share the concerns of noble Lords on this matter.
The Office for Health Improvement and Disparities has a key role in working across government to shift the dial on health disparities. When it comes to physical activity—if noble Lords will excuse the pun at this time—we know that it is not a level playing field. The people who we most need to support include older adults, those in most deprived areas, those with a disability, those with one or more long-term health conditions, those who were asked to shield and those from various ethnic minority groups. That is where it is important to have a trusted source of independent scientific advice on health improvement issues and policies, including physical activity. This will ensure that decision-making is evidence led and that there is a clear focus on addressing disparities.
In setting up the new Office for Health Improvement and Disparities, the Government are bringing together scientific and public health expertise with policy  development to ensure that prevention is at the heart of our agenda. The Government believe that that is the essential objective of a department of state rather than one that would be better carried out than an arm’s-length body. The new office takes a holistic approach, which includes the promotion of physical activity as well as a much wider agenda to enable a more active nation and improve health. We must address those health disparities, which have to be at the forefront of the agenda. I thank noble Lords who took part in the meeting for recognising the importance of keeping the words “disparities” and “improvement” in there.
My noble friend Lord Moynihan asked about the Health Promotion Taskforce. This is driving cross-government efforts to improve the nation’s health and reduce disparities. The Prime Minister launched the task force. Under his leadership it will work to drive improvements. The next meeting will be chaired by the Secretary of State for Health and Social Care and focus on air quality, physical activity and active travel. We recognise the importance of ensuring parliamentary engagement and accountability as work progresses and I can assure noble Lords that we will feed their views and those of the Select Committee into the deliberations of the task force. We also recognise parliamentary scrutiny and accountability and the enduring and valuable interest of noble Lords across the House in seeing progress in this area.
If they will forgive me, I will write to noble Lords with the details of how the task force will be held accountable. More broadly, I am sure that the House will want to hold Ministers accountable for progress, as noble Lords so ably do. The task force is focused on physical activity and active travel, and I will make sure that I continue to update noble Lords as we make progress. I hope that this provides some reassurance to my noble friend and to other noble Lords who joined the call yesterday, as well as noble Lords across the House.
We are committed. All Governments have made mistakes. We have got to do this in a joined-up way. We believe that, with the Prime Minister at the top pushing this from No.10 across government, making sure that we can all work together, we have learnt the lessons. I also hope that noble Lords whom I spoke to yesterday and in this Chamber tonight who have shown an interest in staying for this debate will also hold us to account. For that reason, I ask my noble friend to consider withdrawing the amendment.

Lord Moynihan: My Lords, I have to say that that is the best statement that I have heard in support of sport, health and well-being from the Front Bench for many a decade from all parties. It is exceptionally welcome to hear from the Minister early in his response the importance of the agreement to an ambitious national plan. That is something that the Select Committee was very much looking to and, in fact, it was a central plank. To hear from my noble friend that the Prime Minister will be chairing the Health Promotion Taskforce and that its first meeting will be considering physical activity as a key aspect of the work of that task force is also exceptionally welcome. To hear from the Minister that the deliberations of the Select Committee and the comments made this evening in the debate from everyone,  including members of the Select Committee and other who have contributed, will be passed to the task force for its consideration is also welcome.
We heard from the Minister that it was vital that, for this whole initiative to be successful as a catalyst for change in the sector, accountability is key. We push for accountability to Parliament because, if that can be done every year and Parliament can consider the outcomes of the work of the Health Promotion Taskforce and the other bodies that he mentioned, that accountability itself will be the much-needed catalyst for change. So I thank my noble friends in sport from across the House and the Minister for his response.
It was echoed, I might add, by many hundreds of responses from across the worlds of sport and recreation during the work of the Select Committee. The overwhelming majority were in favour of a national plan. I am very grateful to noble Lords who have stayed to this late hour to hear this debate. Given the assurances that the Minister has given, I beg leave to withdraw.
Amendment 179 withdrawn.
Amendments 180 to 182 not moved.

Amendment 183

Baroness Sugg: Moved by Baroness Sugg
183: After Clause 164, insert the following new Clause—“Permitted locations for abortion treatment(1) The Abortion Act 1967 is amended as follows.(2) In subsection 1(3) after the first “section” insert “, or section 1A of this Act”.(3) After section 1 insert—“1A Approved places(1) The home of a registered medical practitioner is approved as a class of place for treatment for the termination of pregnancy for the purposes only of prescribing the medicines known as Mifepristone and Misoprostol to be used in treatment carried out in the manner specified in subsection (3).(2) The home of a pregnant woman who is undergoing treatment for the purposes of termination of her pregnancy is approved as a class of place where the treatment for termination of pregnancy may be carried out where that treatment is carried out in the manner specified in subsection (3).(3) The treatment must be carried out in the following manner—(a) the pregnant woman has—(i) attended an approved place,(ii) had a consultation with an approved place via video link, telephone conference or other electronic means, or(iii) had a consultation with a registered medical practitioner, nurse or midwife via video link, telephone conference or other electronic means; and(b) the pregnant woman is prescribed Mifepristone and Misoprostol to be taken for the purposes of the termination of her pregnancy and the gestation of the pregnancy has not exceeded nine weeks and six days at the time the Mifepristone is taken.(4) Nothing in this section should be taken to affect any approval otherwise made by the Secretary of State under subsections 1(3) or 1(3A) of this Act.  (5) For the purposes of this section—“approved place” means a hospital in England or Wales, as authorised under section 1(3) of this Act, or a place in England or Wales approved under that section;“home” means, in the case of a pregnant woman, the place in England or Wales where a pregnant woman has her permanent address or usually resides or, in the case of a registered medical practitioner, where a registered medical practitioner has their permanent address or usually resides.””

Baroness Sugg: My Lords, Amendment 183 in my name, if accepted, would maintain the existing provision of at-home early medical abortion following a telephone or video consultation with a clinician. It is very late in the evening, but this is an important issue which will impact hundreds of thousands of women. The existing provisions, which the amendment simply transcribes into the Bill, were adopted in March 2020. It is a straightforward and narrow amendment with the sole purpose of retaining a service that has been in place for the last two years.
Early medical abortion, which can take place up to 10 weeks into a pregnancy, involves two medications. Previous government policy in England was that only the second pill could be taken at home, with women having to attend an abortion provider in person to take the first pill. The approval that was put in place simply enables women to take both pills at home. This was a pandemic-led shift to telemedicine, but the clinical benefits of telemedical service were known even before Covid-19, with NICE recommending it in September 2019. Sadly, following a government announcement a few weeks ago, this approval is currently set to be removed in August this year.
At this point, we should briefly be clear on what removing the existing provision would affect. It would have no impact on the requirement for face-to-face consultation, for face-to-face safeguarding, for ultrasound scans or to be seen in person by both doctors. Any of those changes would require amending existing regulations and that is not what we are debating tonight. The only thing impacted by this amendment is the requirement for women to visit a clinic and then leave again. I hope noble Lords agree that we can focus on just that.
There is no medical reason why telemedicine, alongside interpersonal appointments, should not remain a permanent option. There is overwhelming evidence that allowing women the option to access early medical abortion at home, where clinically appropriate, has created a safer and more effective service. During the pandemic, the largest ever study of UK abortion care, published by the British Journal of Obstetrics and Gynaecology, found that this service shortened waiting times and enabled women to receive care much earlier in their pregnancy. Some 150,000 women have received telemedical abortions since March 2020 and the data on the number of women presenting to NHS services with complications has shown a decrease. Renowned medical bodies support its use, including the Royal College of Obstetricians and Gynaecologists, the Royal College of General Practitioners, the Royal College of Midwives, the British Medical Association, the Academy of Medical Royal Colleges and many more. Just last week, the World Health Organization made it a key part of its global guidance on abortion care.
It is not just the medical experts who want to see this service made permanent—women do too. A recent study in the British Medical Journal found that 89% of women who have used a remote abortion consultation would choose to have treatment at home. It helps women who may struggle to find the time and travel the distance to an abortion provider. This includes those who have childcare or caring responsibilities, who struggle to take time off work, who live in remote or rural areas with little transport and many other logistical, social and economic reasons. Importantly, it can also be a lifeline for women in vulnerable situations. Maintaining the service is fully supported by women’s groups, including Women’s Aid, the End Violence Against Women Coalition and Rape Crisis, which say that it enables women in controlling and abusive relationships to access essential medical care. Removal of telemedical abortion provisions would almost certainly lead to a resurgence in women seeking to access unregulated pills bought online. Without telemedicine, waiting times will rise and current staffing levels would be insufficient.
There is a serious risk that some women would, as a result, be unable to access legal abortion care, either because the providers do not have the capacity or because increased waiting times push some women over the legal limit. Of course, face-to-face services must still be provided for all women who require or request it. However, to take away from women a service that has proven safe, accessible and compassionate, and which enables women to deal with a difficult situation in the comfort and privacy of their own homes, is not the right way forward.
This amendment follows the guidance of medical professionals and would deliver on the Government’s aim to listen to women and put them at the heart of the women’s health strategy. I believe the case is clear and hope that the Government will accept this amendment. I beg to move.

Baroness Fox of Buckley: My Lords, in speaking to this amendment, I apologise for not having spoken in Committee. I want to do so because I have received hundreds of emails urging me to vote against this amendment. I want to explain why I will vote for it—if there is a vote—and why the people who emailed me are worrying about the wrong thing. I emphasise that this is not about changing the law.
I will not make a long speech because the noble Baroness, Lady Sugg, explained the amendment brilliantly and thoroughly. I will make just a couple of points. Over the past two years, the Department of Health, the Government and SAGE—everyone—have told us to follow the evidence. The truth is that this telemedicine, pills-by-post approach to termination pre 10 weeks’ gestation is simply a medical practice innovation that is safe, effective and follows the best clinical practice. So I want to follow the evidence.
About the only positive outcome of the pandemic I can see is that an enforced pilot scheme has given us evidence of the efficacy of this. We also know, as has been mentioned, that many women appreciate this option because there is no clinical need for them to attend a clinic for this procedure. I really cannot see why the Government cannot see that women who do not need hospital care or in-clinic services to access a  procedure should not be forced to take up valuable appointment slots and staff time and unnecessarily squander resources that would be better used to intervene in genuine medical emergencies.
Despite all this, I understand that, for many people, the issue of abortion cannot be reduced to evidence or medical practice because they have moral concerns. I assure them that nothing in this amendment, which is literally about the location where a woman swallows a pill, touches on moral values. This is not a law change. Who can and cannot have an abortion remains exactly the same. The grounds on which abortion is legal remain exactly the same. It is common sense and pragmatic as a matter for women but, if you are morally opposed to abortion, you will still be morally opposed to abortion because nothing in this amendment will change your moral objection. Be reassured: you must have a different fight but not on this amendment, which is total common sense. The Government should accept it.

Bishop of Durham: My Lords, I begin by paying tribute to the noble Baroness, Lady Sugg, for her tireless work on gender equality and areas of international development. We have often been collaborators on such matters. I also apologise to the noble Baroness if she has personally received any hurtful comments on this; some of the things I have seen were shameful. She should not have been abused in this way. Nevertheless, I will oppose her amendment; I hope she understands that this in no way lessens the way in which I honour her for her work.
I declare at the outset that the Church of England’s position on abortion is principled opposition, with a recognition that there are strictly limited conditions under which it may be preferable to any available alternative. My opposition to the amendment is based on that in part but also because I believe that the amendment is functionally inadequate in providing the necessary protections. This was a temporary measure introduced during the pandemic to allow continued access to abortion services, simply to meet a need in extraordinary circumstances. I support the Government’s decision to return to the pre-pandemic system for early medical abortions from August, which was supported by many in the public consultation response.
I also share the concerns of respondents to that consultation around the potential for coercion, the greater possibility of inaccurate assessment, further complications and lack of support. It is of utmost importance that women are safeguarded from coercion and abuse, that they receive accurate and effective medical care through proper assessment, that complications are minimised, and that support is provided to those who need it.
The concerns that I and others have about this kind of at-home early medical abortion are not sufficiently mitigated by the amendment, and in-person visits to a clinic or medical centre continue to be vital. Supporting the vulnerable and creating thorough and effective legislation to do so must be our priority, hence my opposition to the amendment. I conclude by repeating my honouring of the noble Baroness, Lady Sugg.

Baroness Watkins of Tavistock: My Lords, I support this amendment, to which I have added my name. Evidence-based practice that utilises modern technology for the assessment and delivery of treatment for people who choose to take the first pill at home is cost-effective. I think we forget that the majority of healthcare workers, be they medics, midwives or nurses, try to provide person-centred care. Person-centred care means that some women will still be asked to come into the clinic to take that tablet because it is the best solution for that woman.
However, some women live in rural environments where there are very poor bus services. When I went to the women’s meeting at the UN three years ago with other Members of this House, young women representing the four country youth parliaments told harrowing tales of women who had been given the tablet in a clinic but had not got home before the spontaneous abortion commenced. We heard very good examples, particularly from some other countries in Europe, where taking the tablets at home was already normal practice.
The largest study on telemedical abortion in the world was conducted in the UK, covering 52,000 women both before and after the change—in other words, using the natural experiment that occurred as a result of lockdown. There was no change in adverse incidents, no change in successful completion rates, a reduction in waiting times, a reduction in gestation at treatment and it was preferred by women. This evidence was used by the US Food and Drug Administration to make the first tablet at home a permanent option at the end of last year. As the noble Baroness, Lady Sugg, has just said, the World Health Organization issued its international Abortion Care Guideline last week. Telemedicine and self-management of abortion outside a healthcare facility are both in there.
This amendment would enable better person-centred care for the majority of women, as well as for their families and often their partner who will be with them at the time—particularly for people who are perhaps having a third or fourth child which for clinical reasons is not advised. I therefore hope that the fact the majority of people here have a free vote means that they really consider what I have just said.

Baroness Eaton: My Lords, health and safety have arguably never been more front and centre in our nation’s thinking and approach to healthcare. The Government prioritising healthcare in one of their flagship Bills is therefore expected. I am proud of our Government.
As proud as I am, I feel equally perplexed as to why the amendment tabled by the noble Baroness, Lady Sugg, seeking to override the Government’s decision to end the temporary policy on at-home abortion would garner any serious consideration, given that it would contradict the aims of the Health and Care Bill by placing the health and safety of women and girls at risk. It also distracts from important matters in the Bill, for which the Bill was intended.
The provision allowing at-home abortion made alongside a host of other Covid regulations during an unprecedented global crisis was only ever meant to be temporary alongside almost all other temporary provisions  of the Coronavirus Act that the Government are expiring or have already expired. The Prime Minister said that the Covid restrictions
“take a heavy toll on our economy, our society, our mental wellbeing and the life chances of our children”.—[Official Report, Commons, 21/2/22; col. 45.]
The health toll could not, in the specific case of the temporary provision allowing at-home abortion, be more apparent; it is a toll being taken on vulnerable women and girls. As highlighted by a submission to the government consultation on this matter, the lack of in-person consultation increases risks of potentially life-threatening conditions being missed, pills being prescribed beyond the 10-week limit, more women being coerced into a home abortion against their wishes and pills being obtained fraudulently.
These are not unwarranted concerns. Soon after the temporary policy was implemented, story after story emerged of the tragically painful experiences women underwent as a result of this policy. For example, a Telegraph article reported on a nurse whose at-home abortion led to extreme complications needing surgery. Indeed, there have been several cases of women taking these abortion pills outside the legal and safe time limit. For example, in May 2020 police investigated the death of an unborn baby after a woman took pills received by post at 28 weeks pregnant. Such cases are unsurprising given that abortion providers cannot ensure that at-home abortion pills are taken by the intended person in the intended circumstances and time. According to the American College of Obstetricians and Gynecologists, only half of women accurately recall their last menstrual period, again reaffirming that medical confirmation of gestational period is critical.
Given the vast evidence base highlighting how this policy has placed women’s health and safety at risk, an evidence base thoroughly reviewed by the Government in an extensive three-month consultation, I urge the noble Baroness, Lady Sugg, to withdraw her amendment but if she does not, I urge noble Lords to vote against it.

Lord Alton of Liverpool: My Lords, it is a pleasure to follow the noble Baroness, Lady Eaton, and I rather agree with the points that she has just made. But the noble Baroness, Lady Sugg, also knows that I have considerable admiration for her, especially over issues around the stand she took about cuts to our overseas aid programmes; we had the privilege of serving together on the Select Committee of your Lordships’ House that deals with international relations and defence. She will not be surprised to know that I find myself in disagreement with her and I urge your Lordships to think seriously about Amendment 183.
I will give the House two reasons for this, if I may. One is procedural and the other is more substantive. I suppose on the substantive point, I will cite, as the noble Baroness, Lady Eaton, has done, some of the contradictory evidence that we have before us. Your Lordships may not be able to work out whether you believe one side of the argument or the other, and that brings me straight to the point about procedure.
Here we are at almost midnight. This issue has never been debated at any stage in another place in the elected House. Rather like Amendment 170 that we discussed  earlier, we have to consider how we resolve sensitive and controversial ethical issues of this kind. There was no consideration of this question in the elected House, and it has come to us without being considered in Committee but at the fag end of Report stage. Surely all of us can agree, wherever we come from on the more substantive point, that this is not the way to go about parliamentary business.
We should bear in mind that since 1967, when the original legislation was passed in another place and then approved here, there have been 10 million abortions, which is around 200,000 every single year. Put another way, there is one abortion every three minutes. You do not have to come from the position that I think noble Lords will be aware that I come from, of believing in the sanctity of every human life, to think that this cannot be right. Indeed, my good friend Lord Steel, who was the mover of the original legislation, has often said that he never intended abortion to be as widespread or repeated as often as it has become.
This all points to the question of procedure. Should there not be a joint committee of both Houses to consider this extraordinarily complex ethical question? Should we not at least have a Select Committee that considers these matters? Should there not be pre-legislative scrutiny before a Bill or an amendment of this kind comes before Parliament? It is passing strange that since 1967, no Select Committee of either House has looked at this legislation, the original Abortion Act 1967. I say to the noble Baroness, Lady Fox, who always makes valuable contributions to your Lordships’ House, that we are changing the law. That is why this amendment is before your Lordships’ House this evening. We would not need the amendment if we were not changing the law.
I also ask those who have rightly emphasised the importance of conscience, and particularly some of my friends and noble friends on the Lib Dem Benches, why this is not a conscience vote. Why is there a Whip on an issue of this kind?

Noble Lords: It is!

Lord Alton of Liverpool: I am glad to hear that, because I was sent a document earlier on saying that there would be a Whip and that people should vote “Content” for this amendment.

Noble Lords: No.

Lord Alton of Liverpool: If that is so, I am glad to hear it. Noble Lords will know that, for me, this issue led to my leaving the Liberal Democrats when it became a party policy, so I would love to hear clarity on that question as the evening goes by. I passionately believe that this should be a conscience question for every Member but also at every vote. This should never be a party policy; people should be free to make up their own minds on a serious ethical issue—one of such magnitude and order that it should not be dealt with in such a perfunctory manner.
It was the noble Lord, Lord Kamall, who said that this
“was always intended to be a temporary measure.”—[Official Report, 10/2/22; col. 1820.]
In February, in announcing its end, the Government gave the results of a public consultation. Some 70% of those who responded said that it should end immediately. The consultation highlighted increasing safeguarding risks and “concerns about coercion”. Reinforcing that point, last weekend, BBC “Newsbeat” reported that 15% of women in a Savanta ComRes survey said that they had experienced pressure to terminate a pregnancy. Some women reported being given substances to cause an abortion without their consent.
I would be very happy to share with the noble Baroness, Lady Sugg, some of the contradictory evidence from GPs and doctors. She cited the RCOG and others, but I point out that, again in that ComRes poll, 86% of GPs surveyed across the UK were concerned about women having a medical abortion past the legal limit of 10 weeks gestation. Concern was highest among female doctors, at 91%. Six in seven GPs were concerned that the policy could see more women being coerced into abortion. Some 86% were concerned that women were at risk of being coerced into an abortion by a family member or partner, and 87% were concerned that women were at risk of unwanted abortion arising from domestic abuse by partners controlling or monitoring their actions. Some 94% agreed that staff at abortion providers need to ensure that they are collecting correct medical and personal information to certify a woman for a home abortion, and that it is important that checks are put in place to ensure that women being certified for abortion meet legal criteria. So, there is contradictory evidence, and surely that should be properly evaluated before we proceed in further liberalising our abortion laws.
A study released in November 2021 suggested that more than 10,000 women had to receive hospital treatment following the use of medical abortion pills in England between April 2020 and September 2021. Previous polling showed that 92% of women in Britain agreed that a woman receiving an abortion should always be seen by a qualified doctor. There are many statements from women that, again, I could provide to the noble Baroness, should she wish to see them.
The hour is late, so I will conclude. An email from a regional chief midwife described how women had to attend emergency departments for a range of incidents, including
“significant pain and bleeding related to the process through to ruptured ectopics”,
and
“major resuscitation for major haemorrhage”,
and incidents involving the delivery of infants who, as the noble Baroness, Lady Eaton, told us, were up to 30 weeks’ gestation.
The evidence suggests that official statistics appear to significantly underestimate the complications and risks. The Minister will have seen that 600 medical practitioners have signed a letter highlighting concerns and calling for the cessation of the temporary measure. This is worthy of proper scrutiny and consideration. It involves the safety of women, but it also involves the taking of a new life. Science teaches us that life begins at conception. Surely, we should give this proper and due consideration before passing this into law.

Lord Bethell: My Lords, I am grateful to the noble Lord, Lord Alton. I join him and the right reverend Prelate the Bishop of Durham in paying tribute to my noble friend Lady Sugg for her work on women’s issues—work that I support in every way I possibly can. I think that this amendment is a useful amendment to this Bill. My noble friend Lady Sugg is right that the world is changing: science raced ahead during the pandemic, and many things that had not been tried before were tried. Clinical tools have become more sophisticated, practices are undoubtedly evolving and there are definitely lessons from the pandemic that are worth our consideration.
That is why I very much welcome an opportunity to stand back and reflect on what has changed since 1967, which the noble Lord, Lord Alton, referred to, when the current settlement on abortion was agreed. That was an incredibly important moment, when those with different views engaged with public opinion, clinical judgment, ethical analysis and spiritual leaders. I accept that that settlement made in 1967 will not last for ever. In fact, I agree with my noble friend Lady Sugg that the arrangements that have been in place for many years definitely need a second look. If we agree that the moment is right, I emphasise that any reconsideration of these issues should be done in a thoughtful, considered fashion and that we should engage the large number of people who have strong feelings, as well as expert opinion.
We need to do this because these issues are extremely complex and the evidence is conflicted, and they engage so many different strands of our emotional, spiritual and intellectual life. If this this debate this evening is a starting gun for that process, I would recognise its significance and ask the Minister to reflect on the moment in his comments.
However, if this amendment is a realistic attempt to bring about a significant long-term change to the clinical pathways of our health system, I would be extremely alarmed. Regarding the point made by the noble Lord, Lord Alton, on procedure, I have serious concerns. There is no value in blowing up the long-term arrangements that were agreed in 1967 in a late-night Report debate on an amendment introduced at the last minute to a Bill that is about the integration of our healthcare system. It would be a travesty if the easements that were brought in to cope with a global pandemic were used as a pretext for a long-term rewriting of our abortion laws. We were promised that that would not be the case, and it would be regrettable if this Government went back on those reassurances.
I draw to the attention of noble Lords the report by Gynuity Health Projects, published in March 2021, on its study of the efficacy of telemedicine abortion. It found that 5% of participants using the medical abortion treatment at home needed surgical intervention to complete the procedure. These are worrying numbers and are worthy of further investigation before the current situation passes into legislation.
My hope is that this amendment is regarded for what it should be: a testing amendment to stimulate debate and not a serious effort to overturn arrangements that need to be reformed, not overturned. That is why I call on the Minister to explain why this amendment should not stand, and on my noble friend Lady Sugg to confirm that she will not be moving her amendment.

Baroness Finlay of Llandaff: My Lords, I find myself conflicted over this amendment. I am probably the only person in this Chamber who has consulted women over abortions, signed forms for abortions and performed abortions and I have been with women during late abortions for foetal abnormality. It is a complex area. I have also had women say to me, in the privacy of the consulting room, just before they go, “I have never told anybody else this before”—they have then told me about the serious abuse that they have suffered.
My worry with the first part of the amendment, on remote consultation, is that you do not know who is on the other side of camera or who is standing in the room with the woman. You do not know whether the man is using fertility and sex as a form of abuse and is standing there threatening the woman to proceed in one way or another. We know that men refusing to use condoms is a common form of coercive control of women.
The abortifacient tablets, to which my noble friend Baroness Watkins referred, are a separate step. It is inhumane to expect women to take those and then travel on a bus or even go in a taxi. Knowing what has happened before, I cannot help feeling that there is another step. Yes, let the women have their tablets and take them in the privacy of their own home. It is not pleasant to undergo an abortion—nobody should think that it is—but those women also need support and contraceptive advice as part of the package. I am concerned that I do not see that in this amendment and I have been concerned that during the pandemic the ability of women to access contraception may have become more difficult.
This is a complex issue. It is about a pathway with many steps in it. I wonder whether we should return to it at Third Reading, rather than trying to take a yes or no decision tonight on something that has some merits but also some problems. We are not adequately going into them by having a short debate now.

Baroness Stowell of Beeston: My Lords, it gives me great pleasure to follow the noble Baroness, Lady Finlay, whose contribution reflects her extensive wisdom and knowledge in this area. I just want to say that I commend my noble friend Lady Sugg for her leadership in bringing forward the amendment. I, too, will listen to what the Minister says in reply this evening, but instinctively I support what my noble friend is seeking to achieve.

Baroness Bennett of Manor Castle: My Lords, I rise briefly to support Amendment 183. My background in this goes back to March 2020, in those difficult, scary, early days of the pandemic, when your Lordships’ House was operating on a skeleton crew. That led to me, as very new Peer, moving the amendment to the coronavirus regulations that would have allowed for telemedicine. I thank the noble Baroness, Lady Barker, who I note has signed this amendment, for supporting me through that process, because I had little idea about what I was doing in terms of your Lordships’ House. It is worth noting that we were doing that in part in acknowledgement that women would not otherwise have access to the necessary medical service of an abortion,  but also because we knew that NHS resources were going to be enormously stretched. We are still in a situation where NHS resources are enormously stretched. Earlier we were talking about the Ukrainian refugees whom we will be welcoming here and the medical services that they will need.
Of course, we want to say that, in this area of medicine, we should be putting resources into all the NHS services that women need, but the evidence is overwhelming that telemedicine abortion is giving women a better service. I pick up the point made by the right reverend Prelate that there may be safeguarding concerns. There is evidence, particularly from MSI Reproductive Choices, reporting a major uplift in safeguarding disclosures, including from survivors of domestic and sexual abuse, with telemedicine.
On the medical side of this is a simple clear fact: since telemedicine has been introduced, complication rates from abortion have fallen by 20%. You do not have to listen to just me on this; permanent provision of abortion telemedicine is supported by eight royal colleges and medical societies, including the Royal College of General Practitioners, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the British Medical Association. I also point out that abortion telemedicine is going to continue in Wales and Scotland, based on the evidence. The arguments are simply overwhelming: this is the best option.

Lord Sentamu: My Lords, I was not going to speak on this, but I listened to the noble Baroness, Lady Finlay, and that encouraged me to stand up and speak, together with other noble Lords who are a bit cautious about all of this. I was a vicar of an inner-city parish in which there were a lot of teenage pregnancies, and those who made them pregnant tried to force them to have abortions. The only person they felt they could tell was the vicar, not their parents, because their parents would hit the roof. Some of them would get corporal punishment as a result. I found myself in difficult, tricky situations, but I was fortunate, because in the congregation we had midwives and doctors. I simply said, “I listened to what you are saying to me, but I am not medically qualified to give any advice. We have experienced people who can give you that advice.” I was grateful that those midwives and doctors were able to accompany these teenage girls and help them come to a more sensible position.
I speak as somebody who is not against abortion, because the welfare of the mother and her rights need to be protected, but I am concerned about a measure that was brought in because of extreme circumstances. The Government were right, during the pandemic, to allow the kind of arrangement that was set up. But I am with the noble Lord, Lord Bethell, that we should not change overnight a tradition and circumstances that were accepted by the majority who see the right of abortion. We should not say that we will now go down this almost administrative route as the norm. Most people would be very concerned if we were going down a particular route.
I strongly believe, because of my experience of those teenage pregnancies in Tulse Hill, that the role of doctors, specialists in counselling and others is  absolutely vital. You cannot do away with that because it is easier at the end of a telephone. You may not believe it, but young boys who had made girls pregnant would put pressure on them to have these abortions, for no reason other than that they wanted to move on to the next young girl. I still find that unacceptable.
I am reminded of the Mau Mau rebellion in Kenya, when most of the clergy of the Church of England were white. Congregations wanted to have communion, but they knew that if a white person turned up at a church during Mau Mau, they would be killed. So they took the decision that the lay people within the congregation should celebrate communion. That happened. Then Mau Mau ended, and the Church in Kenya said, “Oh good, we can now have lay celebration of communion, because these white people won’t be killed any more because Mau Mau has ended.” Archbishop Randall Davidson, who was Archbishop of Canterbury at the time, said, “During Mau Mau, it was a good thing that communion was celebrated by lay people, but it must not continue, because the old order was to establish who should be celebrating.”
We have been through this very difficult period. I am not so sure that measures that were appropriate during that time are appropriate now and should simply be rolled over. We need a fuller debate and it cannot come at the end of this stage. It was not there at the beginning, when there would have been a lot of debate. I would find it difficult if the Minister accepted the amendment, because the Government announced that this measure would come to an end, like all the other measures brought in because of extreme circumstances.

Lord Duncan of Springbank: My Lords, I have listened to many remarks this evening. There are three things we must remember. First, this approach was brought in during a time of necessity and it has worked. Not only has it worked but it has worked well. It has worked well for vulnerable groups; it has worked well for the wider community, and we should not lose sight of that fact.
Secondly, as we consider what we must do next, we must recognise that it has worked and, on that basis, we should move towards the next step, which is recognising how we can move this forward. It is not an easy issue; it is late at night, but at the same time, we are building on what has already been done. In so doing, we must recognise what can be done further.
Finally and importantly, there is a much wider issue. Many noble Lords have touched on it this evening. That needs to be addressed in the appropriate place, but it is not tonight. Tonight, we have a very simple amendment. It is a very careful amendment and a very simple extension of what we expect to deliver. On that basis, I hope the House will support the amendment. It is simple, it is straightforward, it is right and it is timely.

Lord McCrea of Magherafelt and Cookstown: My Lords, I appreciate the lateness of the hour and, therefore, I want to make just a very few comments.
Without apology, I believe in the sanctity of human life. I believe that it is important to preserve the life of a mother. It is also right to preserve the life of the  unborn child. When this measure was originally presented, it was clearly stated that it was an emergency policy introduced because of the unprecedented circumstances of the coronavirus pandemic. The policy was said to be time-limited but many, like me, feared that this was another way of extending abortion on demand. However, many noble Lords accepted that the at-home abortion powers would be exercised only temporarily and be used only for the purpose for which they were granted and in a manner proportionate to the situation. I commend the Government for the actions they took to turn the coronavirus crisis around to the situation we have today. Therefore, continuing the policy is not proportionate, although I did not think it ever was.
At-home abortion endangers the health of the woman and the girl. Consultation revealed that among a number of concerns raised about safety the most common was the risk of women being coerced. I do not think that is an unimportant issue for this House to consider. Therefore, I shall oppose Amendment 183.

Baroness Smith of Newnham: My Lords, I want to intervene briefly, partly because I believe I set a hare running which I perhaps need to explain. I want also to ask the Minister replying to the debate a few questions.
I am told that I am not whipped to vote for this amendment, even though the Liberal Democrat Whip is to support the amendment—those of us who have a conscience reason not to support the amendment do not have to do so. I take that as being not a free vote, which is why I was of the view that, nevertheless, we were being whipped. Make of that what you will. I shall be voting against the amendment, unless the Minister can clarify certain points.
We heard from the noble Baroness, Lady Sugg, in introducing her amendment, and the noble Baroness, Lady Fox, that essentially this amendment changes nothing about the law on abortion. But we have also heard that if that were the case, we would not need this amendment at all. If it changes nothing, why is this amendment here? So it must be changing something. What I am not at all clear about is what protections are actually in place. The 1967 legislation was very tightly drawn. The nature of abortion in 2022 is much more widespread. The provisions are not perhaps quite as Lord Steel would have anticipated.
This is a very detailed amendment. We have heard that it is very simple but it is also very detailed. It explains who women need to see. They are supposed to be seeing people either via video or via telephone. I do not know whether any of your Lordships experienced telemedicine during lockdown, but it is not always very effective. If virtual medicine means a telephone call not on a smartphone, your doctor cannot see you. They have no idea how you are presenting or whether you are vulnerable. There is a real question about what certainty there is. Can the Minister say what security there is about telemedicine?
We also heard that women would still have to go through normal medical tests and so on. Where is this happening? In the amendment, all we hear about is things being virtual. At what point do we know that a woman is nine weeks and six days pregnant when she takes the first tablet? How do we know that she is not  actually 22 weeks pregnant and not seen by anybody? How do we know what certainty there is? If this is, for many people, a conscience vote, do noble Lords, in good conscience, believe that telemedicine actually means that women are understood and their needs really recognised? Do they get the care that they would get if they were having consultations in a surgery?

Baroness Brown of Cambridge: My Lords, at this very late hour, I just rise to say that I hope your Lordships will not confuse individual anecdotes, however moving, with the very extensive scientific evidence base quoted by the noble Baronesses, Lady Sugg and Lady Watkins.

Baroness O'Loan: My Lords, what is proposed in this amendment is a fundamental change in the law. What we must look at is, I think, fundamentally for each woman, what actually happens in each situation, and what care is provided for the woman in that situation.
I believe that the Government were right to say that this provision would come to an end and that it is not necessarily safe. There are major uncertainties for many women when they conceive. They do not always know when their last period was, as noble Lords have said. But it is not just that. They do not always know the nature of their own medical health and the consequences of taking the telemedical abortion pills.
In that period after 2020 alone, 10,000 women needed hospital treatment for the complications arising from telemedical abortions. It is not an anecdote but a scientific fact that losing a baby, whether by miscarriage or by abortion, is a very bloody and, on occasion, very painful business, which gives rise to all sorts of problems and complications.
All we need to do is to ensure that we do not pass law which does not provide proper care for women. We need to ensure that they do not feel that they are taking up their GP’s time if they seek to consult them about taking these tablets. In a moment, at a time of panic or distress, when they may be subject to coercive control of many kinds, they should not be in a position in which they can be forced to seek this medication when what they need may be care, space and time. BBC polling has shown that 5% of women aged 18 to 24 reported that such substances were given to them without their consent. We cannot protect these women if we allow this amendment to pass. I therefore ask your Lordships to vote against it.

Baroness Barker: My Lords, I wish that many Members of your Lordships’ House who have spoken this evening could have come to the meetings that I have attended in the last two years with people from organisations such as the Royal College of GPs and the Royal College of Obstetricians and Gynaecologists. They would have heard many of the fears that have been raised this evening addressed.
It is important that noble Lords are aware that we are talking a proposal which stems from clinically led, peer-reviewed scientific research in international journals, versus anecdotes. They are not equivalent. Those professional bodies, from the start of the change in the law, were addressing all the issues which noble Lords  have raised this evening. In particular, it is important to state that we are not talking about people having to ring up some kind of remote service which is very minimal. They are talking to people who are skilled interviewers, trained to look for the signs of coercion and to detect them. Indeed, the evidence has shown that having this service has enabled service providers to find women who are being trafficked and coerced. That is one additional benefit that has come out of this service.
A further benefit to have come out of it is that women—desperate women—are no longer seeking unregulated medicine, which they will do if this service stops. The evidence behind this is overwhelming and I ask the noble Lord, Lord Bethell: why should this service not go ahead? I know, and I think that he will know, of other medical services which have changed because of lockdown and are being rolled out—cancer therapies, for one. So why this one? Why is it always the women who are at the back of the queue when it comes to equity and fairness?
I do not think that there is any doubt about the safety of the procedure. I have heard people such as the noble Lord, Lord Alton, make speeches like that before and I understand that they are absolutely and totally opposed to anything that enables a woman to access an abortion service in any way. I accept his moral point, but to all other noble Lords I say: please go and look at the evidence, and look at who is telling you that this is the right thing to do for women.

Baroness Stroud: My Lords, Amendment 183 was tabled in the name of my noble friend Lady Sugg and, like many others, I want to honour her for her commitment to vulnerable women and international development. There are a number of reasons why I cannot support this amendment, but, first, it is important to be clear what it is and is not actually about. In many of the emails that have been flying around from supporters on both sides of the argument, and the various stories in the media, it would appear that Amendment 183 is about abortion and easier access to it. However, although the subject matter is one of abortion, in practice this amendment is significantly more about the health and protection of women.
First, let us take a look at why this is not an abortion amendment. Perhaps, in this instance, I may be able to address some of the recent comments from the noble Baroness, Lady Barker. In the UK, in practice if not in law, we have abortion on demand up to 24 weeks. In 2020, there were 209,000 abortions for women resident in England and Wales—the highest number since the Abortion Act was introduced. This stands in a context where, in the same year, there were 613,000 live births. So, there was roughly one abortion per three live births. We also have access to the morning-after pill without question, and in 2018-19, there were 91,000 procured from sexual and reproductive health services—and that does not include pharmacies. Also, in today’s world, pregnancy tests are as sensitive as Covid tests, so women know from a much earlier stage in their pregnancy whether they are pregnant—not like in my day. It is quite clear that over time, women have been able to take control of their body and their reproductive choices.
If this is not an amendment about abortion, what is it about? With all due respect to the noble Baroness, Lady Sugg, public policy is littered with the results of the unintended consequences of policy decisions. In the name of wanting to serve women, this amendment removes protections for women and leaves them vulnerable and isolated at a time when support, both medical and emotional, is needed. For those of us who participated in the Domestic Abuse Bill or have taken a stand against violence against women and girls, this should cause concern. So, let us take a look at why and how it removes protection for women.
This amendment, as is obvious, provides for a telemedicine service, and the consultation takes place by phone. Hence, an ultrasound is not available. These pills, though, are deemed safe only if they are taken up to nine weeks and six days into a pregnancy. But, without accurate date keeping, and without an ultrasound to confirm the development of the baby, it is impossible to check this on the phone. Taking pills in a more developed pregnancy can be high risk, and this amendment completely abolishes the necessary checks, balances and safeguards that were previously in place to protect the health of the women involved. My noble friend Lord Duncan said it has worked and worked well, but there were over 50 cases officially reported to the Department of Health and Social Care of women who were provided pills by post beyond the 10-week gestation period, including one where, as we have heard, the unborn child was at 28 weeks’ gestation, well beyond the legal limit. There is simply no way of knowing across a phone call the actual gestation period of the baby.
It is difficult to quantify the number of complications that have arisen from these pills, such as incomplete abortion and continued bleeding, because of insufficient data collection on patients receiving the pills. This is where my noble friend Lord Bethell’s comments are appropriate and need to be heard tonight—that significantly more work needs to be done around this issue. FoI requests have revealed the aftermath from the pills by post process to include sepsis, haemorrhaging, embolisms, renal failure and trauma to pelvic organs, among other medical complications.
Secondly, the amendment leaves women to bleed on their own and opens them up to increased health risks. It is extraordinary to me that many of the arguments used against back-street abortion that drove the introduction of the Abortion Act 1967 seem to be being ignored by this amendment. It puts women back to bleeding on their own, in their rooms at home, passing the early stages of the baby into the loo, and all without medical care—the very thing the Abortion Act 1967 was passed to stop.
Finally, this amendment leaves women open to coercion, as we have heard this evening, by actors within the home who do not want a child. We need to be acutely aware that self-administration of abortifacient medication in this way removes the opportunity to check whether abuse or coercion are involved in the decision. This poses a threat to vulnerable women and girls who are at risk from an abusive partner, or from child sex abuse.
Noble Lords this evening have quoted from the Savanta ComRes poll that 77% of women believe that doctors should be legally required to verify in person—

Baroness Thornton: My Lords, I hesitate to intervene at this late hour, but the noble Baroness is making what can only be described as a Committee or Second Reading contribution. Perhaps she should think about that before she continues much longer.

Baroness Stroud: I understand the noble Baroness’s sentiment. Had there been a Second Reading or Committee opportunity—that is, had this amendment not been introduced on Report—there would have been no need to make these arguments at this stage.
Tragically, we know that such coercion has been happening. A further Savanta ComRes poll commissioned by the BBC and reported on Monday showed that 5% of women aged between 18 and 24 had been given something to cause an abortion without their consent. Noble Lords have already quoted some of the data from these polls.
This amendment sounds so nice—pills by post in the comfort of your own home—but, in reality, it leaves women medically exposed and vulnerable to both health complications and coercion. I totally understand the motivation of the noble Baroness, Lady Sugg, in bringing it forward, but I urge noble Lords not to vote for an amendment that would remove protections, expose women to health complications and increase the risk of coercion.

Baroness Walmsley: My Lords, before I make any comments about the amendment, I want to make it very clear that this Front Bench believes that it does not change the law on abortion. It is just about access to a safe and legal medicine, which is why we have encouraged our colleagues to vote for it. However, it has been made clear, both in the written Whip and verbally by me at our group meeting this afternoon, that any Liberal Democrat who feels that they have a conscience or ethical reason why they want to vote against this amendment is quite free to do so. That happens all the time on these Benches, actually; it is not unusual.
I have been keeping a little tally. Adding in the noble Baroness, Lady Thornton, who has her name on this amendment, I calculate that 10 women and one man—I thank the noble Lord, Lord Duncan—have spoken in favour of it. On the other side, there are four men and four women. I think it is pretty clear that, of those in this House who felt strongly enough about the amendment to speak at this late hour—most of them briefly, thankfully—there is a majority of women who think that the availability of this medicine, which all the royal colleges have made clear they believe is safe and effective, should continue.

Baroness Neville-Rolfe: Some women across the Benches may not have spoken because they are conscious that the House needs to proceed with this Bill, even though they might put themselves in the camp with the other four women.

Baroness Walmsley: I absolutely accept that point.

Baroness Penn: My Lords, on Report, only short questions of elucidation are allowed.

Baroness Walmsley: I accept that a lot of people have shown some self-discipline and resisted speaking, but the tally is 10 women in favour and four men and four women against—and the noble Lord, Lord Duncan, on the side I am on.
Despite what has been said, I still do not believe that this amendment changes the law on abortion. It is about access to medicine and, often, access for the most vulnerable women. I accept that it is difficult to speak at this time of night about an issue such as this but, quite honestly, if the Government had thought that this medicine was as dangerous as some noble Lords have suggested, it would have been very remiss of them to allow it to go on for the past two years. Indeed, as I have said, all the royal colleges believe that it is safe; it is also legal, of course, and very acceptable to women. I, for one, think that women should continue to have access to it; I hope that noble Lords will vote for that to happen.
The only reason why this amendment had to be brought in now is that something has changed, which is that the Government have said that they will take it away from women. That is why we have not had a previous opportunity to discuss it.

Baroness Thornton: My Lords, following on from the comments of the noble Baroness, Lady Walmsley, the reason that we are discussing this now is because the Government made their announcement on 24 February about what they intended to do. That means that this is our first opportunity to try to suggest two things.
First, this is not an extension of abortion rights. The people who have spoken against it have been, in general, the people who always speak against women’s rights to control their fertility. I have been in this House for 23 years and involved in many such debates. That is the first important thing to say. Whatever the reasons—including the noble Baroness, Lady Stroud, talking about bleeding at home—actually, most of the women in this Chamber will have had miscarriages at home on their own and coped with that happening to them.
It is a bit rich when the noble Lord, Lord Alton, questions the suitability of this issue being discussed when he is a past master, with our support, of bringing forward the issues that he cares most about in Bill after Bill until he succeeds. We have supported him in doing that. I am not suggesting that he should support us at this point, but I should just make the point regarding the suitability of Bills lending themselves to those who are campaigning on issues.
The second reason is that the noble Lord the Minister in front of us and his predecessor talked about the importance of innovation and of using the good things that were developed in the health service as a result of the pandemic. This is one of them. The noble Baroness, Lady Barker, is quite right. Why should this one issue, that has worked, that women want, given that all the statistics that the noble Baroness, Lady Brown, quite rightly mentioned in her succinct contribution were peer-reviewed and scientific, not continue? Women want this and it is safe.

Earl Howe: My Lords, I am grateful to my noble friend Lady Sugg for bringing forward the amendment. I know that many noble Lords on all sides of the House have strong feelings on this issue. Indeed, it is because any change to the law on abortion is traditionally a matter of conscience that the amendment will be subject to a free vote on the Government Benches if a vote is called.
Noble Lords will be aware that, as a temporary measure, in response to the Covid pandemic, an approval was issued in accordance with the Abortion Act 1967 that allowed women to take both pills for early medical abortion at home at gestations up to nine weeks and six days. We announced on 24 February that there will be a six-month extension to the approval and that the approval will end at midnight on 29 August 2022. From that point, the arrangements set out in the pre-Covid 2018 approval, which allows women to take the second pill for early medical abortion at home only, will be reinstated and face to face services will return.
The temporary measure was put in place at the start of a public health emergency to address a specific and acute medical need, reducing the risk of Covid-19 transmission and ensuring continued access to abortion services. At the time, a decision was made to time limit the approval for two years or until the pandemic was over, whichever was earliest.
The Secretary of State has decided that the provision of early medical abortion should return to pre-Covid arrangements from midnight on 29 August 2022. He has done so for three principal reasons: first, in the light of the success and impact of the national vaccination and booster programme; secondly, having carefully considered all the responses submitted to the Government’s public consultation on whether to make permanent the temporary measure; and thirdly, on the basis of wider evidence regarding the provision of the service since March 2020. Of course, we will continue to work closely with abortion providers and the Royal College of Obstetricians and Gynaecologists—alongside NHS England, NHS Improvement and the Care Quality Commission—to support a safe and reliable return in six months’ time.
The noble Baroness, Lady Smith, asked about the protection afforded to the woman by the temporary approval. The change, as introduced by the temporary approval, was to enable a woman seeking an abortion to consult a clinician via a teleconsultation. If the clinician was satisfied that the conditions laid down in law for approving the request were met, she would be prescribed both stages of the requisite medication for use at home. The responsibility rests with the clinician to ensure that all the necessary conditions are satisfied. That is, essentially, the protection.
The intention of this amendment is to halt this process and overturn the Secretary of State’s decision. In our view, this is not the appropriate way to achieve the intended policy objectives. The legal approval framework already exists in statute, and primary legislation should not be used to circumvent that. Parliament decided to give the Secretary of State a power to issue approvals under the Abortion Act 1967. It did so for good reasons. It would be inappropriate to specify such details about how, and where, healthcare services  are carried out on the face of primary legislation. It would hinder the ability to account for external circumstances such as pandemics, or to account for changes in medicines used for such procedures. This is why the existing approvals power allows the Secretary of State flexibility to make decisions about how healthcare in this area is provided. This can be adapted quickly and easily to respond to changes in service provision or other external circumstances—just as was the case in 2020, when the temporary approval was made in response to concern about the risk to services caused by Covid; and, in 2018, to permit home use of the second medication. This framework works and a change to primary legislation does not need to be made.
Finally, although I do not want to labour this point, it is far from clear what my noble friend intends by wording the amendment as she has. The amendment as drafted would create legal uncertainty for both women and medical professionals, in a highly sensitive area of law, by including wording on the statute book that does not in fact change the law in the way in which it would appear. That is a real difficulty for noble Lords who might be inclined to support the amendment—but it is not the reason why I ask the House to withhold support for it. Ministers have made a decision on this issue and have done so responsibly on the basis of the powers given to them under law. I respectfully suggest to my noble friend that it is right for that decision to stand.

Baroness Sugg: I am very grateful to those noble Lords who have stayed up until this hour to discuss this important amendment, and I grateful to the Minister for his answer. However, I am disappointed by it.
On the argument around these regulations being temporary, we now have the evidence of their success, as we have heard. Since they have been introduced, the World Health Organization and medical professionals have been clear that their advice is that this service should stay. The removal of this service represents a step back, when in all other areas of telemedicine we are moving forward.
On evidence, we really should be looking at the largest ever UK study into abortion, which took place just before telemedicine was introduced and just after. That showed that the rate of complications fell significantly. On complications themselves, the same procedure happens and it is going to continue to happen. Voting against this amendment is not going to remove early medical abortion; it will just allow women to maintain the choice of taking a pill at home.
I want to briefly address the issues around vulnerable women and safeguarding because that is incredibly important. Of course, safeguarding is a really essential part of all healthcare. But there is evidence, as noble Lords have cited, that telemedicine is helping to improve safeguarding, with providers reporting a major uplift in safeguarding disclosures, including from survivors of domestic and sexual violence—particularly from women in abusive relationships. It is more common to be forced to keep a pregnancy than to end one.
Those who work closely on gender-based violence, coercion and abuse will tell you that the solution to reproductive coercion is to get stronger reproductive  rights. Women’s Aid confirmed to me just this evening that it is fully supportive of keeping the service, as making abortion access more difficult does not prevent coercion. In fact, it does the opposite. The very fact that vulnerable women are being used as an argument against maintaining the service which is going to benefit them, I find very difficult to take.
This is not a debate about early medical abortion. As I said, it will remain legal. It is not about broader abortion. It is about whether women can continue to choose, receive and take medicine in the comfort and safety of their own home. It does not bring in a new service; it would simply avoid removing an existing service that women are using safely.
I really do not want to keep anyone any longer, and I appreciate there is diversity of opinion in your Lordships’ House. I respect that people have deep-seated views on abortion. But I believe we should listen to the medical experts who are clear on this matter. We should listen to the women who want, need and will use this service. We should stand strongly against what would be a rollback of women’s rights. Telemedical abortion care has been repeatedly proven by peer-reviewed, clinician-led large-scale studies to be safe, effective, accessible and preferred by women. It is what the medical professionals advise, and it is what women want. I believe that is what should guide us in this vote. I would like to test the opinion of the House.
Ayes 75, Noes 35.

Amendment 183 agreed.
Amendments 184 and 184ZB not moved.

Amendment 184ZBA

Baroness Nicholson of Winterbourne: Moved by Baroness Nicholson of Winterbourne
184ZBA: After Clause 164, insert the following new Clause—“Same-sex accommodation(1) NHS England must, as soon as reasonably practicable and within one month of this Act being passed, revoke Annex B to its NHS guidance on “Delivering Same-Sex Accommodation” published in September 2019 (relating to same-sex accommodation for trans people and gender variant children).(2) Where NHS England issues revised guidance on the same subject, it must ensure that it takes account of the exceptions provided under paragraphs 26 to 28 of Schedule 3 to the Equality Act 2010 (which allow for separate services for the sexes and single-sex services).”

Baroness Nicholson of Winterbourne: I thank noble Lords for waiting for this very late debate and assure them that the intensity of feeling about this is not reflected by the numbers in the Chamber tonight. Indeed, we had a debate on this a couple of weeks ago. The debate on this amendment tonight still demands the withdrawal of annexe B, which gives priority to trans people over women. But despite the words “trans people”, we believe that this is a debate about the rights of women to have their dignity, privacy and safety reaffirmed and brought back into the centre because those three things have disappeared. There is a rising tide of misogyny in society today because of social media. The NHS should be behind us in supporting women because of our priority needs in health.
I suggest that trans rights, instead of having priority over women’s rights, which has happened because of annexe B, should be reconciled with but cannot trump the dignity and safety of all patients. No one patient, save  for medical reasons, should be prioritised over anyone else. I think that that is one of the most fundamental failings of the 2019 annexe B, which talks quite differently from that. Some 51% of the population is being deprived and the protections that we had took at least 50 years to come through. Indeed, I suggest that the rights of women are a priori a touchstone for any civilised society. We have got it wrong. We have somehow changed course.
I suggest that Parliament sets the law and creates the common position for society on any aspect of life. Indeed, we are omnipotent and omnicompetent—not necessarily this Chamber, but the other Chamber. Yet self-ID, which is at the heart of annexe B, has deliberately been pushed through, almost surreptitiously, without debate in either Chamber. I think that that is scandalous and I am a parliamentarian of many years’ standing in different Parliaments. For me, the heart of this debate is that Parliament has been ignored and bypassed and surreptitiously something far-reaching has been brought in that affects all families, all faiths, all identities and all levels of society. In place of sex-based rights, we are giving priority rights to one special section of society.
I have every respect for that section of society. Indeed, I must have been one of earliest Members of Parliament to tackle transgenderism in my constituency. One of the most delightful people came to see me. I knew the parents well—ancient parents—and I knew the families, I knew the village and I knew the farms. This person came in because she was in a dreadful state. She had become fully altered, both physically and through drugs. Because she had been away doing that for some time—it had taken at least a year and she had gone abroad—when she came back her job had disappeared. When she reapplied, she was placed at a much lower level, which meant less status, less salary, fewer holidays and more misery, as it were, because she felt thoroughly demeaned. She was, in fact, a member of the police and it was not easy at that moment to persuade the police that this was a fully acceptable thing to have done. I think that, in that sense, I have won my colours on transgenderism. It was not easy, but I managed it. It was not easy socially for her and I helped on that as well.
None the less, we are in a different situation today, whereby my gender—my sex—has been made less dignified in hospital by a backdoor attempt. Our amendment seeks to reverse this and to include the very limited opt-outs in paragraphs 26 to 28 of Schedule 3 to the Equality Act 2010 to protect single-sex spaces in hospitals. On the filleting of the relevant schedule, which has been placed in annexe B to justify this elite position of one small branch of society, I suggest to the Minister that I have not seen that filleting of legislation anywhere before in Britain. I have seen it in new democracies. It is a terrible thing to do, because you are cheating the public. You are saying that this is in fact the law, when it is not. You have filleted it. That is what has happened with annexe B. I am really shocked by that as a parliamentarian, irrespective of the subject. That is fact; it is a very wrong thing to have done.
I am not at all happy that the current review fulfils best practice either. Having raised this for two or three years with Ministers and having received very  little response, I have been informed twice now that there is a review. Indeed, I think that there are two reviews going on, if not three. However, I suggest that the one I believe the Minister is in charge of, to which he referred, is again in breach of the Government’s own regulations on how a review is conducted. Those regulations, which are quite old, are rather good. They are very clear, and they are very simple. They say that you must not have people who have skin in the game running a review, yet that is exactly what has happened.
In the Daily Telegraph today, a whole batch of rather wonderful women who do not sit in this House, alas, but run various women’s organisations and are medical have declared correctly that they have not been invited to give evidence. In other words, this review has been done without input from the very people who know more about it. I offered to give evidence myself, but I was not wanted. That is a different matter; I am not medical, so that may be perfectly fair. But these women are very special indeed and they have not been consulted. This means that women, generally speaking, have been left out of the review.
Worse than that, even, is that the people running the review, who I know—they are fantastic people such as the chief of nurses, the LGBTQ adviser, and so on—are wonderful, very interesting and hugely knowledgeable people, have more than skin in the game: they are the game. I believe it is not right, therefore, that a review that matters so much to 51% of the population and to their families should be conducted in this way. So I am rather unhappy about the review, too. It is being rushed through in parallel with this Bill. I suggest that it does not meet the Government’s own guidelines on consultations on reviews. There is no impartiality and the review team has tremendous interests—that is all too easy, but it does not give the right result.
I remember, again as a Member of Parliament, a massive review being conducted by the European Union into farming. My constituency had many farmers, and they came to see me because they were worried about what might come out of it. I found out from our own files here in London who was on the consultation—and, of course, there was not a single farmer. This is rather the same thing, I would suggest.
Of course, a number of colleagues in this House take their briefings from a lobby group called Stonewall. Stonewall has declared in its briefing for responses to this debate that any comments from me and others—the noble Lord, Lord Blencathra, for example—should be responded to by saying, “Blah, blah, blah”. I suggest that this is infinitely too serious for such a response.
Finally, I draw to the House’s attention the fact that I have been requested on a number of occasions by the Minister and others to give examples of what I am talking about. This is not at all easy, because all the examples given to me have been given in confidence. Whereas I know who they are—some are medical professionals and some have already had their jobs threatened—I can see why they do not want to be known.
However, a rather wonderful lady—I cannot say who she is—was raped in hospital by a man about a year ago. There is only one definition of rape in Britain and that is male on female; you cannot rape if  you do not have the structure of a male. She was raped and she naturally reported it to the police. The police spoke to the hospital, which informed them that there was no male in the hospital, therefore the rape could not have happened. They forgot that there was CCTV, nurses and observers. None the less, it has taken nearly a year for the hospital to agree that there was a male on the ward and, yes, this rape happened. It is on record—I know where the case happened, who the police are and where the hospital is. I know everything about it because she gave me the full case to make sure I knew that what she was saying was true.
During that year she has almost come to the edge of a nervous breakdown, because being disbelieved about being raped in hospital has been such an appalling shock. The hospital, with all its CCTV, has had to admit that the rape happened and that it was committed by a man. The police have therefore changed their tune and become enormously supportive and helpful, and the case is going ahead. However, this has arisen directly from annexe B. The result of annexe B is that hospital trusts inform ward sisters and nurses that if there is a male, as a trans person, in a female ward, and a female patient or anyone complains, they must be told that it is not true—there is no male there. I refer there to the duty of candour in the National Health Service. I think it is completely wrong that the National Health Service should be instructing or allowing staff to mislead patients—to tell a straightforward lie. It is not acceptable. The National Health Service is admired globally and the duty of candour makes it imperative that it should be frank, open and honest with the patients, yet trust after trust has informed its staff that they must say the opposite of the truth when this situation arises. The impact on my new friend is appalling. I beg to move.

Lord Etherton: My Lords, I rise to oppose this amendment despite the eloquence of the noble Baroness, Lady Nicholson of Winterbourne. It is an important starting point, and it is clear from what the noble Baroness said and the terms of the amendment that it is not intended to change the Equality Act. It appears to be a comment on how that Act is applied in relation to this guidance, so the question is whether annexe B to the September 2019 guidance is consistent with the existing law. I say that it is entirely appropriate and consistent with the anti-discrimination law in the Equality Act.
Gender reassignment is a protected characteristic. The Act defines that protected characteristic in very wide terms. It includes where a person is proposing to undergo, or is undergoing, a process, or part of a process, for the purpose of reassignment by changing physiological or other attributes of sex. This means that a person may have the protected characteristic without having undergone full surgical reassignment, let alone having a gender recognition certificate. It will be sufficient, for example, if they had adopted attributes of a different sex, such as name, dress or hair, in their intended process of transition.
The Equality Act prohibits discrimination or harassment on account of a gender reassignment. Harassment is defined in very wide terms as engaging in
“conduct related to a relevant protected characteristic”
and that conduct has the effect of “violating”, in the case of gender reassignment, the trans person’s dignity or
“creating an intimidating, hostile, degrading, humiliating or offensive environment for”
that person.
Under the Equality Act, a person who provides a service to the public, which would include the National Health Service, must not discriminate against a trans person in the terms on which the service is provided; nor can they subject the trans person to any other detriment or harass them. The service provider must make reasonable adjustments where appropriate.
If matters stopped there, the NHS would be acting unlawfully in failing to allocate accommodation and other facilities to match the gender identity of transsexuals. There are limited exceptions to those requirements and they are contained in Schedule 3 to the Act. Amendment 184ZBA refers itself to paragraphs 26 to 28 of that schedule; in fact, paragraphs 26 and 27 are irrelevant, as they deal with sex discrimination.
Paragraph 28 is relevant. It says, in relation to gender reassignment discrimination, that a public service provider does not contravene the Equality Act only because of anything done in the provision of separate or different services for persons of each sex or
“the provision of a service only to persons of one sex”,
provided each of those cases is
“a proportionate means of achieving a legitimate aim.”
This means that any permitted derogation from the anti-discrimination and anti-harassment provisions governing the NHS in relation to trans people requires a case-by-case appraisal. Any derogation must be for a legitimate aim. It is not a legitimate aim that some people feel uncomfortable sharing accommodation and facilities with trans people of the opposite birth sex. That would make a nonsense of having the statutory protected characteristic in the first place. Crucially, any derogation must also be proportionate, which means the least discriminatory in all the circumstances.
In light of this legal framework, I can see nothing at all wrong with the 2019 NHS guidance. It correctly identifies trans people who have the protected characteristic under the Equality Act. The guidance says that trans people should be accommodated according to their gender presentation. It recognises that reasonable adjustments can often be made to ensure the dignity of trans people, such as by giving privacy by the use of curtains or accommodation in a single side room adjacent to the gender-appropriate ward, and that a trans person may be placed in an otherwise opposite-gender ward if—but only if—that is proportionate to achieving a legitimate aim. In that context, the guidance refers to a safe nursing environment, but it would also extend to safeguarding requirements, where relevant. The guidance contains similar provisions for children and young people.
All in all, this is entirely consistent with the statutory framework. In my view, this amendment is fundamentally misconceived.

Lord Russell of Liverpool: My Lords, with apologies to the House and particularly to the noble Baroness, Lady Brinton, whom I should have called earlier—but it is early in the morning—I invite the noble Baroness to speak.

Baroness Brinton: My Lords, it is a pleasure to follow the noble and learned Lord, Lord Etherton, who very carefully laid out the law on the Equality Act and how it fits in with the guidance.
The amendment from the noble Baroness, Lady Nicholson, on same-sex accommodation in hospitals, returns to her concerns about the balance between the Equality Act and NHS guidance Delivering Same-Sex Accommodation. I note that the Minister said in Committee that
“NHS England is currently reviewing the 
The current NHS guidance is already rooted in the Equality Act 2010 and includes guidance on accommodating trans people. That does not mean that women are excluded. The guidance was created in 2010 and updated as recently as 2019. As the noble and learned Lord, Lord Etherton, said, it is very clear about the reasonable adjustments for trans people, but that does not remove the core principle that all patients should be safe and dignified.
Amendment 184ZBA seeks to create a false understanding of the ways in which this works. It would also revoke annexe B in its current form, but, frankly, that is unnecessary, because the Equality Act 2010 and the guidance already provide an effective mechanism for inclusion in the context of single-sex spaces. The whole point about annexe B is that it guides NHS staff in how to deliver same-sex accommodation for trans people, which is a very small number of patients, and probably most NHS staff have not had trans patients. It does not supersede the Equality Act. It is accompanied by the NHS safeguarding policies, underpinned by the Care Act, which set out how children and vulnerable adults will be protected from harm and abuse.
The problem is that the amendment would create a blanket policy against trans inclusion in NHS accommodation, resulting in trans women having to be accommodated in men’s NHS accommodation and trans men in women’s NHS accommodation. This would create an environment that was contrary to the dignity and well-being of patients. The amendment is therefore unnecessary and, frankly, harmful. It also goes against the careful NHS guidance and breaches the key element in the Equality Act, which the Minister reminded us of in Committee. He said:
“This means that the rights and needs of women and trans women are equal in law”.—[Official Report, 9/2/22; col. 1725.]
Above all, there is no evidence to suggest that the status quo is not working. I hope that the noble Baroness, Lady Nicholson, will withdraw her amendment.

Lord Farmer: I rise to speak in support of my noble friend Lady Nicholson and her Amendment 184ZBA, as I maintain that it would bring  NHS trusts back into line with the Equality Act 2010. Part 7 of Schedule 3 to the Act permits discrimination on the grounds of sex and enables provision that is separate, different and/or provided to only one sex if it is
“a proportionate means of achieving a legitimate aim”.
Paragraph 27 of Schedule 3 specifically provides for separate male and female single-sex hospital wards. A hospital ward where patients are, by definition, vulnerable and dependent on their surroundings for safety, privacy and dignity—for example, they are unwell, sleeping, in various states of undress, receiving intimate personal care, confused et cetera—comfortably meets the “legitimate aim” test.
Further, annexe B mis-states who is included under the protected characteristic of gender reassignment by widening it to include transgender and non-binary people. This has no basis in law. Section 7 of the Equality Act 2010 states that the protected characteristic of gender reassignment refers to transsexual people and:
“A person has the protected characteristic of gender reassignment if the person is proposing to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of reassigning the person’s sex by changing physiological or other attributes of sex.”
It is important to establish what percentage of transgender people fit this description. In 2016, a meta-analysis of 27 studies estimated that approximately 0.01% of the population have a transgender diagnosis and/or surgical or hormonal treatment. In contrast, 0.35% of the population self-identify as transgender. This means that only 2.9% of those who consider themselves part of the transgender community are undergoing any gender-affirming treatment. The vast majority, 97.1%, simply self-identify and make no modifications to their natal sex body, so there is a very high probability that someone born male who is supported under annexe B to be in a female ward is genitally intact. The risks this presents cannot be batted away. At the very least, women from religious minorities who require single-sex wards may be prevented from accessing healthcare. Some policies allow known male sex offenders who identify as women on women’s wards.
Further, Explanatory Notes to Part 16, Schedule 3, Part 7, paragraph 28, on separate and single-sex services, show that the Equality Act permits single-sex wards also to exclude patients under the protected characteristic of gender reassignment if that treatment by a provider can be objectively justified—in other words, if there is a legitimate aim as outlined above. Yet multiple NHS trusts have ignored this justification and generated policies based on annexe B which undermine the safety, dignity and privacy of women patients and cause much distress. The NHS has failed to evaluate the effects of the current policy in this area, so there is a lack of objective evidence and data on this issue. But there is much anecdotal evidence from women who have shared their stories with politicians and the media that current practice is harming women in NHS care. This includes women who have been traumatised through violence from men and then retraumatised. Annexe B, in my opinion, is unlawful and should be rescinded.
The NHS should find alternative ways of accommodating transgender patients, rather than removing the safety, dignity and privacy of all the other patients in a ward by making that ward mixed sex.

Lord Clement-Jones: My Lords, given the hour, I shall be extremely brief. As a long-standing supporter of single-sex wards and single-sex provision, I raised the issue of the wording of annexe B and the status of its review in Committee. Tonight, I am continuing to attempt to get answers to questions raised in Committee and in correspondence with the Minister, the noble Lord, Lord Kamall.
It seems clear that the current review of annexe B is not the review promised by the Secretary of State, Sajid Javid, last August. We tried to get to the bottom of this in correspondence. I hope that the Minister, when she responds today, will be able to say exactly what the status of that review is. We have been informed that it is a scheduled, standard internal review—whatever that is—but there seem to be no terms of reference, there does not appear to be any analysis of how well the current provision of same-sex accommodation is working, the review has not been publicised internally, the review team is not independent, and the review seems largely to have been conducted behind closed doors. At the very last moment, certain organisations from which evidence was recommended to be taken did indeed give evidence, in a one-hour Zoom session—and that was about it. So it is a totally unsatisfactory form of review and evidence-taking, and it seems to be moving in a particular direction without any transparency at all.
I very much hope that the Minister will be able to give us much more information about the review, its purpose and whether it is indeed the one the Secretary of State promised; and, if it is not, whether terms of reference will be published publicly so that we can actually have a discussion about how they should be formulated.
I would say, in passing, that it is vital as part of this review that the Government publish what their view about the legality of single-sex wards is. We have already had two interpretations of Schedule 3 to the Equality Act 2010. I tend to agree more with that of the noble Lord, Lord Farmer: paragraphs 26, 27 and 28 seem to me to be utterly clear in permitting single-sex wards in the NHS, and I cannot see how the noble and learned Lord, Lord Etherton, has come to the conclusions that he has. But let us see what the Department of Health’s interpretation is and whether annexe B really does conform to the Equality Act. Let us get down to the basics. It is really important.
Finally, I would simply say that it seems to me that there is no way that annexe B can conform to the Equality Act currently. It says:
“Non-binary individuals, who do not identify as being male or female, should also be asked discreetly about their preferences, and allocated to the male or female ward according to their choice.”
Being non-binary is not a protected characteristic, so what on earth is it doing in annexe B?

Lord Blencathra: My Lords, I am so pleased I waited to hear the noble Lord, Lord Clement-Jones, make an excellent speech. I think what he said is apposite, and I hope the Minister will deal with the point about the quality of this review and how public it will be.
When we moved an amendment in Committee to protect female patients and ensure their rights under the Equality Act 2010 to have NHS hospital accommodation exclusively for women of the biological sex of a woman, a number of Peers, including the noble Lord, Lord Clement-Jones, who did not agree with our amendments nevertheless pointed out that there was a complete disconnect between the general guidance issued in 2019, which stated that women must have their choice of single-sex wards protected as a top priority, and annexe B, which completely undermined that guidance and said that men identifying as women could also be placed in female-only wards.
The general guidance and that annexe B guidance fail to set out the rights that biological women have under the Equality Act; and our amendments seek to rectify that by calling for annexe B to be rewritten as soon as possible and for the new guidance to clearly spell out to NHS trusts the exceptions and rights of women under the Equality Act as far as healthcare is concerned. Who could object to that? Well, of course, the main briefing against this perfectly reasonable suggestion comes from those in Stonewall, a now thoroughly discredited organisation that has abandoned gay women. They have been thrown out of this place, and many other organisations, and yet they push their ideology in contravention of the facts. Stonewall did an absolutely excellent job when it was created, fighting for gay and lesbian equality, but it has abandoned gay people, especially lesbian women, in a feverish pursuit of trans ideology.
When we debated this, and prison units for women, many Peers seemed to think that most trans women had made strenuous efforts to become women. That is simply not the case, as my noble friend Lord Farmer has pointed out. Only a very small minority—well under 5%—with genuine gender dysphoria has taken hormone treatment, had operations and adopted the lifestyle, behaviour and character of women. I salute their courage in all the steps they have taken to change their gender and live in that lifestyle. They should be treated equally, both legally and morally, and there is ample scope in all NHS hospitals to have special provision for them.
But I am afraid that the vast majority of men claiming to be women or self-identifying as women have done absolutely nothing to try to become like a woman, and they simply do not intend to. They want to keep all their male attributes but demand the rights of real women. What sort of men want to invade women’s toilets, changing rooms, safe places and hospital beds, when they have not made the slightest effort to become like women or behave like women? I suggest that they are acting out a perverse fetish whereby they can go into women’s spaces and flash their body parts and get away with it when they would be arrested if they did that outside. Therefore, while we should have the utmost respect for women, men, and men who have genuinely made the change to become women, we should have nothing but contempt for these fake trans women. We may not force a vote on this tonight, but a time is coming soon when we will, and Ministers had better choose the right side.
Last week, the right honourable Harriet Harman said that Labour had a problem with women. I commend her honesty. Also last week, the shadow Home Secretary, Yvette Cooper, was asked to define a woman. Three times, she said that she did not want to go down a rabbit hole on this. Now most dictionaries define the Alice in Wonderland phrase “down the rabbit hole” as meaning entering a strange and absurd alternative universe. The shadow Minister for Women, Anneliese Dodds, was asked the same question on “Woman’s Hour” and said that the definition of a woman depended on the context. So, noble Baronesses, there you have it. Depending on the context, you may or may not be a woman, and trying to define your biological sex more may result in entering a strange alternative universe.
However, of course, there is always a man who can cut through all that nonsense and define a woman. Keir Starmer was able to pronounce that trans women are women; that is the answer of a lawyer, not a doctor. No, Sir Keir: men can legally change their gender and call themselves trans women, but they are still men, not women. No wonder JK Rowling said at the weekend:
“I don’t think our politicians have the slightest idea how much anger is building among women from all walks of life at the attempts to threaten and intimidate them out of speaking publicly about their own rights, their own bodies and their own lives. Among the thousands of letters and emails I’ve received are disillusioned members of Labour, the Greens, the Lib Dems and the SNP. Women are scared, outraged and angry at the deaf ear turned to their well-founded concerns … Now Keir Starmer publicly misrepresents equalities law, in yet another indication that the Labour Party can no longer be counted on to defend women’s rights. But I repeat: women are organising across party lines, and their resolve and their anger are growing.”
I know that most Ministers in this place have a sensible view on this, but they are tied to the policies of Cabinet Ministers in another place. So I say this to my right honourable friends in another place: get off the fence and publicly support women, or suffer the same fate of the opposition parties that are now regarded as hostile to women. Accepting this amendment would be a start to showing that the Government will defend the rights of women to have their own safe spaces, to have their dignity respected and to have the Equality Act properly applied in all NHS facilities.
I am pleased to support my noble friend Lady Nicholson.

Lord Cashman: My Lords, it is late, so I will abandon the speech that I prepared. I absolutely agree with the analysis by the noble and learned Lord, Lord Etherton, of the Equality Act and annexe B in relation to it, as well as of the inclusion of the NHS’s 2019 guidance.
When we address issues of balancing rights, we must always address them on an evidence-based approach and never on anecdotal evidence. Freedom of information requests around the country have shown that there is no evidence to suggest that annexe B in its current form needs to be revised. I could talk about my concerns about what this amendment would cause for trans women and trans men seeking treatment and care in the NHS. I will leave that to your Lordships’ imagination. However, I have to say, hearing the way in which trans women, trans men, trans families and trans teenagers  have been represented by some in this House tonight has left me deeply ashamed. It is part of a continuing narrative to grab something of a minority of a minority and use it to represent the entire minority. It was done to people like me when we were arguing with the noble Lord, Lord Blencathra, when he was in Home Office, for an equal age of consent.
This was the language being used privately and publicly to describe people like me—men like me—to suggest that I was not worthy of being treated as an individual, contributing member of society who should be afforded the same protection of the law and the same obligations to the law. History shows me that the language being used to represent trans women, trans men and trans teenagers—and their mothers and fathers—is exactly the same as has been used against minorities across the centuries to diminish those individuals, to dehumanise and demonise them, and then to remove their rights, including their right to belong.
As the co-founder and founding chair of Stonewall, I am immensely proud of the inclusion of rights which Stonewall has adopted, continues to adopt and will not flinch away from. As an equality organisation, it cannot believe in partial equality; it believes in the equality afforded to individuals regardless of difference. I urge the Minister to respond by calling for the withdrawal of this amendment, which causes me deep, deep concern. Can she please reassure us that any review of the extremely important Equality Act and the guidance of 2019 will be only evidence-based, and that she will then publish the evidence?

Baroness Fox of Buckley: My Lords, I apologise that I did not speak on this issue in Committee. As I had stayed late to speak on the prior amendments in defence of women’s reproductive rights, I decided to stay because this is a natural follow-on. Despite what has just been said, this is actually about women’s rights and women’s concerns that NHS guidance on trans issues effectively undermines the right to have same-sex wards in hospitals. I am not going to rehearse the whole issue around gender identity tonight—we are all far too tired. I want to keep this quite straightforward for me.
The noble and learned Lord, Lord Etherton, rather dismissed these concerns when he more or less said that we cannot pander to people who feel uncomfortable. I want to express something about women feeling uncomfortable. Having been a woman in hospital—when you are at your most vulnerable and needing to feel safe—the idea that you cannot guarantee single-sex wards in that instance is not just uncomfortable but also about rights that have been won. It is a perfectly legitimate right. Women should not be made to feel embarrassed or be patted on the head as if to say, “Don’t you worry your pretty little heads, this is all to do with equality”.
We have just heard a contribution which effectively said “Watch your language”. In response, I say, “Watch what you’re suggesting women should do”—namely, to back off from this issue. I do not think that women should and they will not. It is also the case that not all trans people are represented by trans activists. I know  trans women—yes, this is anecdotal—who do not support trying to have what will effectively be mixed wards, or confusing or undermining single-sex wards in NHS settings.
The noble Lord, Lord Clement-Jones, made a very important point on which I wanted to finish. There are a lot of concerns on all sides, so many noble Lords have said, “Let’s have a review”. It seems that the Secretary of State wants a review, but we now do not know whether or not the review which is happening at the moment is the review he wants. The review happening at the moment is not satisfactory. It is that peculiar internal NHS review which has been referred to.
The review is carried out with no public terms of reference. It all seems to be carried out in secret and is being co-led by Dr Michael Brady, who is the adviser for LGBT at NHS England. I am sure that he is incredibly well intentioned but I suggest that being its LGBT adviser might make him rather the opposite of impartial.
We are now told that the review has looked to Stonewall and Mermaids for support on the review. It has been reported that in December, the lead reviewer wrote to campaign groups supportive of the gender identity position on this issue, assuring them that there were
“no plans to reduce the existing rights of transgender people”.
What I have just said is not evidence at all; it is all hearsay. I am just repeating what somebody said and somebody may have said. I can tell your Lordships that I am not satisfied either because I do not want to find out about this review by reading today’s newspapers, which is basically where I got that information, and leaked emails. This is not satisfactory.
I want the Government to take this seriously and recognise that when somebody says that there are no plans to reduce the existing rights of transgender people, what women hear—if I can translate it—is that women-only wards are not guaranteed at all. I want the Government to be honest with us about what they believe they are arguing for. I also want them to take us away from having to discover these things in newspapers and, instead, assure us that a new review will be set up that is independent and fully resourced—one that has a clear set of terms of reference, which people on different sides of this argument can look at and discuss openly. They should try to detoxify it by bringing it out in the open and having a credible review with all sides of this argument consulted, represented and talked to, and women should absolutely be asked and not given an hour’s Zoom as an afterthought.

Baroness Hunt of Bethnal Green: My Lords, I will be very brief because it is extraordinarily late. I have just a few short observations. First, as a lesbian woman in this House I have spent many years reading Hansard and watching the House’s proceedings, and hearing lesbians being referred to in far less positive terms than they are today. It is quite a contrast to hear from others in this Chamber such concern about lesbian women. I want to put it on record that many lesbians are entirely supportive of the current status quo in relation to the provision for trans people in single-sex and other accommodation. This suggestion  that lesbians are opposed to it is unhelpful. In the spirit of detoxifying the debate, it is important that we stick to the information and facts that are available.
Secondly, there is a review being undertaken. There are many reviews in the NHS but I have heard about this review more times on more platforms, via more mediums, than any other thing that seems to be going on in the NHS at the moment, despite the fact that we are in the middle of a global pandemic. I have contributed to that review. I have written and I am sure that the noble Baroness, Lady Nicholson, has done the same. We are more than capable of lobbying and influencing different institutions to put our view forward. I am curious about the consequences of that review and it will be interesting to see what comes next.
My other observation is that the noble and learned Lord, Lord Etherton, is a very good authority on the Equality Act and I trust him completely. I do not think his analysis is subjective or a hot take. He does know his stuff.
Finally, as the daughter of a mother who trained to be a nurse and then a midwife, and who retired after 40 years as a professor of nursing and midwifery and trained hundreds and hundreds of nurses and midwives, I have absolute confidence in the professionalism of NHS staff to manage tricky issues when they occur. They do not just occur in relation to the 0.002% of the population who may or may not be trans. Those come up in all sorts of areas and I trust the NHS to handle those situations when they do.
I am 42 and expect that the entirety of my life peerage, which I imagine and hope is another 40 years, will contain a lot of these discussions. These discussions will continue, and I hope we can have them in a manner that is respectful towards each other and our different perspectives.

Lord Lucas: My Lords, I am absolutely delighted to be speaking in a debate after the noble Lord, Lord Cashman, and the noble Baroness, Lady Hunt. My biggest beef with Stonewall has been its refusal to debate. By that policy, it has built up a bank of fire and argument which has done a great deal of harm to trans people and to others. If we are seeing an end to that, leading to circumstances under which we can talk these things through—they are not easy issues—and reach a comfortable conclusion, I shall be absolutely delighted. I have asked Stonewall many times if I can discuss things but it has never acceded. Perhaps this is a new beginning.
In the first 20 years of my life in this House I listened to a lot of debates in which women were arguing for single-sex wards. I cannot, on the basis of listening to them, think anything but that it is a legitimate demand; that it is something that really matters—not perhaps to every woman, but to women at large—and that it absolutely constitutes the sort of grounds contemplated in the Equality Act for making something single sex.
It is absolutely clear in the definitions in the Equality Act that trans women are men. So if you have a trans woman in a female ward, that is a man in a female ward and that is against what female wards were intended for.  That is the starting position; it is not the most humane ending position. Like the noble Baroness, Lady Hunt, I have a great deal of faith in the nursing profession to resolve difficult issues and reach the best possible solution. But the starting point should not be annexe B. It should be the Equality Act and the recognition that separate spaces for women—particularly when they are vulnerable—are something that we as a society wish to have.
When we last had a review of the Gender Recognition Act, Stonewall submitted evidence to say that it wished the exceptions under the Equality Act to be removed. I do not start from that position. I start from the position that those exceptions are very important. Nor do I follow the noble and learned Lord, Lord Etherton, in suggesting that the review has to be case by case, as in person by person. It is clear to me from the judgments made under that Act that this refers to the circumstances of an institution. An institution is quite entitled to say that it will not allow any male-bodied people to share a hospital ward purely for female-bodied people.
As I said, I do not regard that as a satisfactory end position. The right way to get to a proper conclusion is debate and a review that is not as obviously biased and unsatisfactory. A review carried out by people so committed to a highly politicised organisation—one embracing the extremes of postmodernism in its attitudes to people—is entirely unsatisfactory. This has to be what the noble Baroness, Lady Hunt, has just called for: a broad conversation and a broad review—one that respects the position people find themselves in. It should be interested in arriving at an evidenced position at the end of it. That is not what we have at the moment. I hope it is what we arrive at and that this House can play its part in that. I am absolutely delighted that at last we have a conversation.

Baroness Barker: My Lords, I too have spent many hours in your Lordships’ House discussing the subject of single-sex wards in hospitals. There is a continuing discussion to be had about single-sex provision in healthcare, but I do not think this debate is about that at all. I think this is a proxy debate for a campaign that is largely the one that was set out by the noble Baroness, Lady Nicholson. It is a campaign which seeks to drive differences between trans people and other women.
The noble and learned Lord, Lord Etherton, was absolutely right in his exposition of the law. The equality law is the piece of legislation that carefully addresses the differences between groups of people and the different treatments that they deserve or are entitled to in order to achieve equality under the law. We have had a variety of views, from the noble Lord, Lord Blencathra, who frequently describes trans women as men, through to some of the rest of us who believe that they are women with a different experience.
The job of the NHS is, and always must be, to provide safe care for everyone. That is why we have had guidance in force for many years that is compliant with equality law. I say again, as I did earlier in our debate, that unless and until the noble Lord, Lord Blencathra, and the noble Baroness, Lady Nicholson, come forward  with evidence that that is not being provided by the NHS, we should simply not pay attention. We should dismiss the amendment.

Baroness Walmsley: My Lords, I sense that the House would like to move to the Front-Bench speeches. I should like to say first that I have not been briefed by Stonewall. My views are my own and not influenced by any lobbying group. I am a woman and I am not going to support the amendment for the reasons that the noble and learned Lord, Lord Etherton, and my noble friend Lady Brinton have made clear: it offers a solution to a problem that does not exist. However, when the Minister comes to reply, I hope that she will give my noble friend Lord Clement-Jones some answers to his questions about the review, because they are legitimate.

Baroness Thornton: My Lords, I need say only a couple of things. First, I should declare an interest as a non-executive director of an NHS hospital that has single-sex wards. My money is definitely on the interpretation of the law given by the noble and learned Lord, Lord Etherton. The noble Baroness, Lady Hunt, is quite right—the former Master of the Rolls probably has a good grasp of this issue. The second thing that she is right about is that I also trust the NHS to be able to deal with the issues that may arise on its wards. In Committee, the Minister correctly said that this amendment was not necessary and I hope that for consistency she will continue to say that it is not necessary because all the aspects are covered by the law and the procedures of the NHS. If there is to be a review, I hope that that is transparent and we will discuss the matter in due course.

Baroness Penn: My Lords, I thank my noble friend Lady Nicholson for bringing this debate before the House today. I understand the sentiment behind her amendment and I am appreciative of all her work advocating for women’s rights. It is an absolute departmental priority that all patients feel safe when receiving NHS services. This is particularly important where patients are interacting with the healthcare system because they may be particularly vulnerable.
My noble friend and all noble Lords are clearly well aware that NHS England and NHS Improvement are currently reviewing the operational guidance on delivering same-sex accommodation to ensure that it remains focused on privacy, safety and dignity for all patients. An internal review of the guidance is the right way in which to ensure that it is fit for purpose and complaint with all statutory obligations. The content of any updated guidance is being informed by engagement with a wide range of stakeholders and in accordance with NHS England’s statutory duties outlined in the Equality Act 2010, including the public sector equality duty. Any revised guidance is due to be published later this year.
I understand that some noble Lords have concerns about the current guidance, and the department remains open to considering this issue further. I reassure all noble Lords that, before publication, Ministers will seek assurances from NHS England and Improvement that it has fully considered whether the guidance is compliant with existing legislation and with NHS England’s relevant duties. However, as it currently stands, accepting this  amendment would pre-empt the outcome of the review of the guidance and NHS England, as part of its review, will be considering the Equality Act 2010 and how it applies to the guidance.
I hope my noble friend can appreciate the need to allow NHS England and Improvement to conduct its review of the guidance in full. NHS England and Improvement is fully aware of importance of the review of the guidance to so many and is working to publish the updated guidance at the earliest opportunity.
It is late and we have had a number of debates on a number of important and emotive issues. I thought I might try to conclude my contribution by finding the common ground I thought I heard in the different contributions that we had to this last debate, and I am sorry if I misrepresent anyone in doing so. I think that everyone agreed that wards should be places of safety and dignity that allow patients to get the care they need; that we need to respect the rights of everyone in looking at how we deliver on that and that, in doing so, any guidance and practice is in line with the Equality Act and the law more generally; that the guidance that is produced is practical and effective for clinicians who are trying to deliver the best possible outcomes for patients; and that we approach this and other issues where there is disagreement or conflict about how we adhere to those aims from a position of evidence, compassion, empathy and respect. With that, I hope that my noble friend feels able to withdraw her amendment.

Lord Clement-Jones: Before the Minister sits down, she has not answered the question about the status of the review promised by the Secretary of State, Sajid Javid, last August.

Baroness Penn: My Lords, it is NHS England’s responsibility to ensure that its own guidance is compliant with the relevant provisions in the Equality Act and works operationally and effectively. That is why NHS England is doing the review of its guidance. As I understand it, the Secretary of State has previously said that he had asked the Department of Health and Social Care for fresh advice on this issue, and he is indeed taking advice from the department on this matter.

Baroness Fox of Buckley: Before the Minister sits down, in view of the recent media revelations, might there need to be a review of the review of the guidance? The review of the guidance is coming into disrepute, and we do not understand how we can hold it to account. I do not want it to be left to newspapers.

Baroness Penn: My Lords, I think it is worth making two points. The NHS review is of operational guidance and is called privacy, dignity and safety and is reviewing the entirety of delivering the same-sex accommodation guidance. This guidance includes annexe B. I thought I had in part answered the noble Baroness’s point in my remarks where I said that I understand that some noble Lords have concerns with the current guidance and that the department remains open to considering this issue further. I also reassure noble Lords that, before publication, Ministers will seek reassurances from NHS England and Improvement that it has fully considered whether the guidance is compliant with existing legislation and NHS England’s relevant duties.

Baroness Nicholson of Winterbourne: My Lords, I am very grateful to my noble friend Lady Penn and my noble friend Lord Kamall, if I could say on behalf of everyone, for all the magnificent work they have put in throughout the whole of this great debate, not just this evening but day on day, week on week, it almost seemed. We are amazed by their dedication and huge competence.
This evening’s has been a very helpful debate. I know that I speak for many noble Lords, including, I hope, my noble friend Lord Blencathra—I hesitate to speak for him because he was once my Chief Whip, so I remain almost silent in front of him. It has been a most interesting and helpful debate and I am confident we can take it further, and with that I withdraw the amendment.
Amendment 184ZBA withdrawn.
Amendment 184ZBB not moved.

  
Clause 166: Regulations

Amendment 184ZC

Lord Sharkey: Moved by Lord Sharkey
184ZC: Clause 166, page 135, line 41, at end insert—“(da) regulations under section 151;”
Amendment 184ZC agreed.

Amendment 184A

Lord Kamall: Moved by Lord Kamall
184A: Clause 166, page 135, line 41, at end insert—“(da) regulations under section (Licensing of cosmetic procedures);”Member’s explanatory statementThis amendment ensures that regulations under the new Clause about licensing of non-surgical cosmetic procedures are subject to the affirmative procedure.
Amendment 184A agreed.

  
Clause 169: Commencement

Amendments 185 to 187

Lord Kamall: Moved by Lord Kamall
185: Clause 169, page 137, line 3, at end insert—“(4A) Section (Child safeguarding etc in health and care: policy about information sharing) comes into force at the end of the period of three months beginning with the day on which this Act is passed.”Member’s explanatory statementThis amendment provides for commencement, three months after Royal Assent, of a new clause concerning government policy in relation to information-sharing by or with authorities with health and social care functions, for purposes relating to children’s health or social care or the safeguarding or promotion of the welfare of children.
186: Clause 169, page 137, line 4, leave out “(4)” and insert “(4A)”Member’s explanatory statementThis amendment is consequential on an amendment providing for commencement of a new Clause.
187: Clause 169, page 137, line 7, at end insert—“(6A) In relation to section 155 (cap on care costs for charging purposes), different days may be appointed under subsection (5) for different areas.”Member’s explanatory statementThis amendment allows the care cap amendments to be brought into force at different times in different areas (which is consistent with the provision made by the Care Act 2014 for the commencement of the sections to which the amendments relate).
Amendments 185 to 187 agreed.

Highgate Cemetery Bill [HL]
 - Returned from the Commons

The Bill was returned from the Commons agreed to.
House adjourned at 2.12 am.